There has never been a safer time or place to be an infant and small child than 2016 in industrialized countries. Ironically, there has never been greater anxiety about the physical, emotional and intellectual status of those same infants and small children.

Why is there an extraordinary disconnect between reality and anxiety? You can thank the cultural conceit of “natural parenting” for problematizing infant and child health … at the very same historical moment when infant and child health are extraordinarily good.

Natural parenting problematizes infant safety in order to pathologize women who don’t conform.

Perinatal mortality, infant mortality, and child mortality are at historic lows. Vaccine preventable diseases have been nearly vanquished. Rates of sudden infant death syndrome are falling. Congenital defects like heart disease can be treated. Malnutrition and vitamin deficiencies are rare. Foods and medications are safer than ever because of government oversight.

But you’d never know that if you are part of the natural parenting culture, which justifies its intrusiveness into maternal choice by promoting fear in regard to infant and child health. Natural parenting advocates inflate risks of rare events to monstrous proportions or invent theoretical risks that have never been seen in real life.

For example, childbirth is inherently dangerous, but has been made dramatically safer by the liberal use of obstetric interventions. Yet to hear natural childbirth advocates tell it, childbirth is inherently safe and any dangers that exist are caused by technology.

Obstetricians are desperate to prevent brain injuries from lack of oxygen. Natural childbirth advocates pretend that the placenta is a miracle organ that never deviates from perfection and that “drugs” used to control labor pain threaten neonatal health.

Infant formula has never been safer or more nutritious. Yet to hear lactivists tell it, breastmilk is lifesaving and formula is deadly.

Vaccines have never been safer or more effective (as evidenced by the bottoming out of incidences of childhood diseases), but anti-vaxxers utterly ignore both medicine and history in denying the public health triumph of universal vaccination. Instead they obsess about rare or even fabricated vaccine injuries.

Food has never been safer. Natural parenting advocates have never been more afraid of food, wasting money on organic produce, blithering about GMOs, and dosing their children with unregulated supplements.

Pediatrics has never been safer or more effective at preventing disease and suffering. Natural parenting advocates have never been more sure that nonsense — homeopathy, cranio-sacral therapy, and herbal preparations — is the key to good health.

Why is there such a tremendous disconnect between reality and belief? Two reasons: privilege and problematizing.

The privilege issue is distressingly blatant. The only fears that count in the world of natural parenting are the fears of Western, white, well off parents.

Poor children and children of color face a plethora of truly life-threatening issues including hunger, lack of access to healthcare and gun violence. Poor children and children of color die each and every day because of these problems, but many privileged Western, white well off parents could care less. They oppose life saving free school meals, Obamacare and sensible gun regulations. Instead they are preoccupied by birth plans, brelfies and baby slings, though none of those do or could save lives.

What’s even more outrageous is that they are so insulated by privilege that they actually believe they are promoting safety by fetishizing birth, breastfeeding, organic food, vaccine opposition and homeopathy.

Using and misusing the language of science, natural parenting advocates problematize infant and child safety.

The natural childbirth industry of midwives, doulas and childbirth educators claim it is evidence based when the truth is that it is based on no evidence at all. They publish papers in industry trade papers disguised as scientific journals like the Lamaze International’s Birth: Issues in Perinatal Care.

Lactivists howl that low breastfeeding rates compromise infant health despite the fact that breastfeeding rates have no correlation at all with infant health. Infant mortality rates dropped precipitously through the 20th century despite the fact that for most of that time period breastfeeding rates dropped like a rock. Indeed, the countries with the highest infant mortality rates in the world have the highest breastfeeding rates.

Attachment parenting advocates have hijacked attachment theory (which postulates that children need only a “good enough” mother) in order to problematize infant attachment. The truth is that mother-infant attachment happens spontaneously, easily and is not contingent on any specific behaviors. In contrast, attachment parents obsess about promoting “bonding” through ritualized behaviors like baby wearing.

The philosophy of natural parenting is a “regime of truth” that has little to do with infants and children and a great deal to do with controlling women’s bodies and women’s lives.

…[T]he discourse on attachment has become another site for the medicalization of motherhood and maternal emotion… The role for women as mothers within attachment theory is considered to be narrow and conservative, promoting beliefs that are contrary to the interests of women. Cleary states that any feminist consideration of attachment theory should be mindful of the way it “not only describes but actively prescribes the nature of our psychological lives and ills”. This prescriptive nature of attachment theory has in turn led to the objectification and pathologization of women and presented women with the need to monitor themselves when it comes to their behavior toward their children.

By promoting fear about their children’s well-being, the philosophy of natural parenting causes women to tightly regulate their behavior so it conforms with the “rules” of natural parenting and to pathologize and blame themselves when they fail in conforming to those rules. Hence the outpouring of guilt and recrimination for epidurals, C-sections, formula feeding and other deviations from natural parenting diktat.

In other words, natural parenting problematizes infant safety in order to pathologize women who don’t conform.

Natural childbirth problematizes pain relief in childbirth in order to pathologize women who don’t accept that pain ought to be part of mothering.

Lactivism problematizes infant formula in order to pathologize women who don’t breastfeed.

Attachment parenting problematizes maternal independence in order to pathologize women who think there is more to life than mothering.

Why has natural parenting become popular despite the fact that it imagines threats to children that don’t exist?

Simmonardottir notes:

… According to Hays, the answer lies in the way the theory fits so neatly with our pre-existing cultural beliefs about the appropriate role of the mother and “operates so effectively as a means to keep women in their place”. Attachment theory “makes sense” for us as it taps into pre-existing ideas about the essential nature of men and women as well as the biological and evolutionary purpose of women’s reproductive abilities, where the relationship between mother and child is made to seem biologically determined but not socially constructed and historically specific…

And, of course, it reinforces the privilege of the privileged:

Additionally, it is important to acknowledge how middle-class, hetero-normative, and Anglo-centric norms of child rearing are assumed within the discourse of attachment theory, making it impossible for certain groups of women to discursively position themselves within the narrative of “good mothering”…

The bottom line is that children are not facing unprecedented threats to health that can only be ameliorated by natural parenting; they’ve never been healthier. Natural parenting problematizes infant/child health and safety in order to enforce a “regime of truth” regarding the appropriate role of women, robbing women of the opportunity to make the choices for themselves and their families that they deem best.

Anecdote here: Amazing Niece was just diagnosed with yet another allergy. SIL would like to know just where these attested, confirmed, proven, etc. benefits of stellar health have gone. After all, the kid was EBF for many months. Only had her first lick of formula when she started trying to chew her mom’s nipples off. By then, she was already allergic.

We’re pleased that at least SIL could pump so she didn’t need to stay with her baby 24/7 to make her the healthiest kid in town which didn’t work anyway. Somehow, I really doubt breastmilk was so much safer for her.

myrewyn

Hey Dr Kitty (or Dr Amy) — in one of your comments below I believe you mentioned that a woman over 40 shouldn’t go past 39 weeks of pregnancy and now I can’t find it back. I’m expecting my third and will be 43 by the time I deliver this one. I’m currently weighing TOL vs planned Caesarian. Can you elaborate on that comment?

“The incidence of stillbirth at term in women is low.
It is higher in women of advanced maternal age.
This at 39–40 weeks of gestation equates to 2 in 1000 for women ≥ 40 years of age compared to 1 in 1000
for women < 35 years old.

Women ≥ 40 years of age having a similar stillbirth risk at 39 weeks of gestation to women in their mid 20s at 41 weeks of gestation, at which stage the consensus is that
induction of labour should be offered to prevent late stillbirth.

There is therefore an argument for offering induction of labour at 39–40 weeks of gestation to women ≥ 40 years of age.

The available evidence suggests this practice would reduce late antenatal stillbirths and maternal risks of an ongoing pregnancy such as pre–eclampsia. The argument is stronger where
there are concurrent medical co–morbidities, nulliparity, or Afrocaribbean ethnicity; all are known to
have higher stillbirth rates.

However, at present there are insufficient data available on the effect such a policy would have on surgical deliveries and perinatal mortality specifically in older mothers. It is
possible that any beneficial effect from prevention of late antepartum stillbirth is reversed by an increase in intrapartum stillbirths and neonatal deaths, although data on women of all ages shows an improvement in perinatal outcome.

There is growing evidence that such a policy would not increase the number of operative vaginal deliveries or emergency caesarean sections. Such issues should be discussed
with women who are older and pregnant."

Basically- if you are 40, your risk of stillbirth at 39 weeks is the same as a younger woman's risk at 41 weeks, when induction is routinely recommended.

As to TOL vs elective CS- that is very much your personal choice based on your own circumstances and past history and you should discuss it further with your care providers.

Best of luck with everything and I hope that whatever you decide it goes smoothly!

myrewyn

Thank you! We were just going to start talking about birth options at my next appointment when I will be ~28 weeks and I wanted to have already done some good thinking about it before I go in. So far everything has gone perfectly with this pregnancy and I don’t feel “old”… but I’m aware of my increased risks. Thanks again for the thorough response.

myrewyn

I just left my 28 week appointment and we are on for a 39 week induction! She brought it up first that with my age she would want to induce by my due date and so it was easy to segue into discussing that study, which she was familiar with. She said she usually starts with discussing a 40 week induction essentially because so many people want labor to start naturally but she agrees 39 weeks is better. I said, oh, as far as my “birth plan” goes just give me all the science! She laughed. Success!

An Actual Attorney

A proposal: Stop replying to nikkilee. She’s a boring troll, and anyone who reads any bit of the comments can see she’s dishonest, an idiot, or both.

The politically correct terms are “pregnant people”, “parents to be” or “expectant parents”, in case you are interested.

Because not all pregnant people identify as women.

Personally, I’m fine with this because I never liked the “mama” stuff, and being addressed in inclusive terms doesn’t bother me.

I await the “mama- wombyn power” contingent tying themselves into knots trying to claim labour and birth as sacred wombyn empowerment while attempting to be trans- inclusive.

nikkilee

That attitude is has been a barrier to transgender women participating in cis-gender womens activities.

nikkilee

The infant formula industry has made China, with its high birth rate, a target for marketing. The rates of childhood obesity are rising; lack of breastfeeding is cited as one of the major factors. https://www.ncbi.nlm.nih.gov/pubmed/23823460

Heidi

“However, no association was found between paternal employment, breast-feeding practice in the first 4 to 6 months, or maternal age at the time of giving birth and the prevalence of overweight and obesity in our study sample.”

Oh Nikki Lee. Can you read?

Roadstergal

You know, I think she’s so used to telling her echo chamber what the studies say that she really has no idea what to do when people actually read them.

So she just ignores that part.

Heidi

I’m glad she’s ignoring it! I guess a true believer won’t be swayed, but her lack of response I think speaks volumes.

swbarnes2

She can read. She’s just a fundamentally dishonest person.

nikkilee

“However, we found the prevalence of overweight and obesity to be significantly associated with maternal employment status. Our study showed that the prevalence of overweight and obesity increased when mothers were employed.”

How are the babies of employed mothers fed? Formula?

MaineJen

OMFG lady. That’s a horrible thing to say. Do you realize that?

Empress of the Iguana People

Not to mention she acts like medieval women didn’t work. *everyone* but the baby had to work. Hard.

Heidi

You are still a horrible, dense person, I see. The abstract spelled it out for you. Formula didn’t cause obesity.

I know you want women back in the home. We got it. Just be honest.

Azuran

Wait, so the study said they found no link between formula and obesity, but found a link between working mothers and obesity.
And what you decide to derive from this is that even though there was no direct link between formula and obesity, it’s STILL formula because you decided (without any proof, might I add) that working mother formula fed more?
And you say that we are the one who are not having an honest discussion here.

Roadstergal

Our workplace has a dedicated mothers’ room for pumping with a fridge for storing. Also, generous maternity and paternity leave. So any working woman here who wants to feed their kids breastmilk and is biologically able to, will.

momofone

My baby of an employed mother was fed breast milk. And it wasn’t worth it. (And with that, I’m out.)

Azuran

seriously, did you even read that? It says exactly the opposite of what you say it does.

Heidi

I think she’s so convinced that formula does all the worst things ever, she just saw breastfeeding and obesity and presumed it agreed with her little fantasies.

nikkilee

CDC agrees that breastfeeding and obesity are connected.

Heidi Fritz

Stick to the damn crapola you posted. You don’t give a crap about what the CDC has to say about vaccines so I take it you don’t even believe the CDC is a credible source. Quit the platitudes for once and respond to the crud you post or what any of us are actually saying.

nikkilee

The CDC has done fabulous work with breastfeeding. I disagree about what they say about new vaccines.

Heidi

I think we are all very aware of what you think. No need to reiterate. None of us thought you wouldn’t think yourself more knowledgeable about vaccines than the sum of people who have gone to school for years studying them and dedicated their lives to them.

Empress of the Iguana People

It’s like there are dramatic, observable effects of vaccines like the lack of polio in most of the world after the introduction of polio vaccine or how rinderpest is eliminated, or something. And how there *aren’t* dramatic between the high formula use among boomers and much higher rates of bf’ing among earlier and later generations.

Madtowngirl

Lactivist logic 101: The CDC, WHO, etc, are all totally credible sources when it supports our ideaology, but not when it doesn’t.

fiftyfifty1

What does the study YOU posted say Nikkilee?

swbarnes2

NIkki, you aren’t fit to judge what is and is good research work. You lie when you claim otherwise. You don’t even read the papers. And you are so fundamentally dishonest you don’t even understand why that’s a problem.

momofone

What does the study YOU posted say?

Aine

High birth rate in China? Have you heard of the one-child policy? Recently relaxed to allow couples in specific circumstances choose to have two children. Not exactly a high birth rate by any standards. This is basic general knowledg.

nikkilee

The population of China is about 1.5 billion people. Enough babies that the formula industry is making China the focus of new marketing strategies and construction of factories.

momofone

Waiting for your response to the comments about what this study actually shows. If you had a shred of credibility you would have responded days ago.

The Bofa on the Sofa

Yeah, I agree with momofone. All this other discussion is distraction from the fact that the study said exactly opposite of what nikki claimed.

She is either a liar or a buffoon. Or both.

Nick Sanders

Companies responding to the presence of an untapped consumer base? The cheek of it!

Azuran

So?
You sure don’t offer your own advice for free. You don’t see CPMs going around in poor neighbourhood to sell their services either, they go where people have money. Lactation consultants charge for their consultations as well.

momofone

Kind of like the way you market your wares to hospitals?

Dr Kitty

A population of 1.5 billion people who generally can’t eat unfermented dairy products after childhood due to lactose intolerance.
There is very little in the way of a dairy industry in China.

With milk being a deeply unprofitable business (bottled water costs more per litre than milk in my local supermarket) dairy farmers are trying to diversify and get as much bang for their buck as possible.

Turning unprofitable milk into profitable infant formula is a good business strategy- exporting to large foreign markets makes sound business sense.

If you want to change that, maybe the solution involves not just promoting breast feeding, but paying dairy farmers a fair price for milk, which means spending less energy protesting formula and more energy protesting your big supermarket chains who continue to drive milk prices down.

Dairy farmers aren’t choosing to sell milk to formula companies for any other reason than because it makes them good money. If they could make better money selling milk to Ben& Jerry for ice-cream, or to make butter or cheese or just selling milk to local supermarkets, they would do that.

nikkilee

Interesting comments. Another reason foreign companies are importing to China is the melamine scandal of 2008. Some say the source of the problem is farmers caught between rising costs and a government cap on prices. The farmers, these critics say, added the melamine to boost the tested protein level of watered-down milk.

Aine

Population size has nothing to do with birth rate. You are using words without knowing what they mean.

MaineJen

“High birth rate” bwahahaha

This word…I do not think it means what you think it means.

Roadstergal

You still haven’t addressed the fact that this study says the exact opposite of what you claim, I see. Does this ‘lying’ stuff fly with the people you sell your services to? Whiffs of fraud, there.

Point? Two children per couple isn’t high birthrate – that’s replacement rate. U.S. and European formula companies make a product that is at least perceived safer and is making money. Is this financial advice? Hey, maybe I’ll invest some money in Mead-Johnson and Abbott!

nikkilee

In 2010, nearly 16 million babies had been born in China. The annual number of births in China has increased continuously since 2010. In 2014, the number of births in China had reached 16.87 million. A replacement birth rate in a country of 1.3 billion is a lot of babies. . . or consumers, depending on who is looking.

MaineJen

Well…naturally, some of those mothers are going to want formula, no? Not all of them will be able or willing to breastfeed, I would think for the same reasons that American women are not always able or willing to breastfeed.

Heidi

So what?

Are you anti-capitalist? Do you think all of us should be growing and raising our own food? We don’t have enough land for that and most of us don’t want to be farmers. If you’re so anti-consumerist, communes still exist.

The only evidence you’ve provided is formula companies provide a product people want and need. Women want to work and they don’t want to stay at home all day. Their baby needs appropriate food to eat and people are willing to provide money for it. Big whoop.

Dr Kitty

Had a lady in the other day who is EBF her colicky baby.
We discussed a 2-4 week trial of a diet which excluded all
Cows milk.
She felt that wasn’t an option (she liked milk in her tea and on her cereal, apparently quite a lot).

So we talked about 2 weeks of pumping and dumping with a hypo-allergenic formula, going back to EBF if baby didn’t improve.
She felt that was too much hard work, but really wanted to continue to BF:

So we decided that in the absence of any clear indicators of cows milk protein allergy that she would just continue to breast feed and we could re-visit the options down the line.

The baby is thriving -no rashes, nothing to suggest CMPA, as far as I’m concerned she can knock herself out.

Either it will grow out of the colic or we’ll end up discussing exclusion diets and hypoallergenic formulas again.

Needless to say, if there had been evidence that baby had CMPI and needed a specialist diet, the outcome would have been different.

This is the UK Supreme Court ruling about consent, specifically as applied to CS versus VB in the case of a diabetic woman whose baby suffered brain damage after shoulder dystocia.

The Court has ruled that risks don’t come down to percentages, but to the importance the patient ascribes to them. Therefore a patient may rightly choose a treatment which avoids a rare but serious risk, even if it confers a higher chance of a risk the patient considers less serious. It is up to clinic and to advise on ALL risks, but the patient to ascribe their own weighting to them.

From everything you have written here you seem to have a problem with this interpretation of patient autonomy and informed consent, in particular how it applies to more and timing of delivery.

Dr Kitty

Sorry- so many typos!!

“Clinic and” should be “clinicians” and “more and timing” should be “mode and timing”.

Dr Kitty

Psst-
Nikkilee- up here!

I’d love to hear your thoughts on this.
It’s been up for 3 hours now, while you responded to other comments downthread, you’ve been silent on this.

Any comment?

*hint- this is another character test and you’re not exactly winning the audience over so far.

nikkilee

I am not here to win over the audience. Thanks for the link. US system is different. I like these comments:

“The Court noted that “the “informed choice” qualification rests on a fundamentally different premise: it is predicated on the view that the patient is entitled to be told of risks where that is necessary for her to make an informed decision whether to incur them”

“The Court also noted how “unreal” [5] it was to place the responsibility on patients to ask about potential risks. This leads to the “the drawing of excessively fine distinctions between questioning, on the one hand, and expressions of concern falling short of questioning, on the other hand” [6], the disregard of “the social and psychological realities of the relationship between a patient and her doctor”[7] and the odd finding that “the ignorance which such patients seek to have dispelled disqualifies them from obtaining the information they desire” [8].”

“An exception to the duty is if the doctor reasonably considers that the disclosure of the risk would “be seriously detrimental to the patient’s health” [12], or in circumstances of necessity. However, the Court made it clear that this exception should not be abused.”

As an American, I am curious- in what scenario(s) would the above exception apply, esp. the “seriously detrimental…” part? (Not just in OB, but in UK medical care generally). Anyone know of any examples?

Dr Kitty

This is basically where you have someone who has a phobia of something which is a million to one chance of happening, but would decide to forego the treatment because of the risk.
Say someone with a needle phobia who is told a procedure had a 1 in 1 million risk of causing diabetes, but the procedure would cure their current condition without problems 99/100 times.

In reality, it is actually very hard to find a real life scenario where withholding information from your patient against their wishes is in their best interest.

Even in extremis, where it is life or death, your patient still has a right to know the risks and weigh them up for him or herself.

I run into difficulties where families don’t want their elderly relatives told their dire prognosis, lest they give up hope.

I can ask the person if they want me to tell them their diagnosis and how much time the have left, but if the person wants to know and they have capacity, I can’t lie to them even if their family wants me to.

Sometimes that causes issues.

ForeverMe

Dr. Kitty, Thank you for answering.

Amazed

OK, boys and girls. Pro-tip from your helpful Amazed: while it might make some sense tp argue with natural and anti-vaxxer loons in hopes that they might see the light and it does make sense to exchange thoughts and arguments with fence-sitters, it’s an exercise in futility to do so with someone who makes living off advertizing naturalness. That’s why you’ll never have a meaningful discussion with nikkilee, as interesting as it was for me to watch your exchanges.

Just thought you might need a reminder. This isn’t your average “researching” mommiest mommy. That’s a professional natural-exploiter.

Nick Sanders

I’m bored, and it’s a bit of a diversion that doesn’t take too much time.

Amazed

I know that about you but I thought it might be helpful to remind people what she is. In discussions, people sometimes forget who they are arguing with.

Dr Kitty

Oh I’m not arguing with *her*, I just don’t like leaving some of her more egregious stuff sit there unrebutted for any lurkers who might be reading.

I’m pretty sure she thinks I made terribly unfortunate choices and feels sad for me, but she doesn’t have the guts to actually say so, knowing that it will just make her look like the blinkered ideologue she is.

Dr Kitty

Correction- horrible thing happened to my friend and nikkilee’s insensitive comment might have been a little to much to take.
So I’m being deliberately annoying.

#sorrynotsorry.

Box of Salt

Dr Kitty “I made terribly unfortunate choices and feels sad for me” Right with you on that one. And she can’t cope with how we don’t fit into her narrative.

nikkilee

No judgements; not taking things personally. I have control over only my own choices. I come here for different reasons, and you have all taught me a lot.

Dr Kitty

Really?
Like what, for example?

nikkilee

That evidence doesn’t change beliefs.

Dr Kitty

What convincing evidence have you, personally, presented?
What was meant to change our minds?

You cited nausea and vomiting as risks of CS, for example, and then happily acknowledged that it is a risk of VB also.
You can’t reason your way out of a paper bag.

What I think you mean to say is that poor quality evidence doesn’t convince well educated people.

You’re right, NOTHING you have posted has in any way changed my belief that your knowledge of up to date research and practice in obstetrics surpasses mine.

Empress of the Iguana People

i’m unconvinced her knowledge surpasses -mine,- and i’m a history teacher. I know damn little.

Amazed

Makes two of us. No, not two history teachers. Two non-medical professionals whose knowledge has moved past the 80s.

Really, with her boasting of her 40 years of experience, I am bound to think of Antigonos. She has about this much but seems to keep her knowledge updated whike nikkilee’s seems anchored in the years I was still playing with dolls.

Heidi

Nikki Lee is very self-centered. It’s not that she’s even stuck in the 80s. Nikki Lee wanted to stay at home with her children when she gave birth, Nikki Lee wanted to breastfeed, Nikki Lee wanted a homebirth so what Nikki Lee wants is what is best and thus what everyone wants. And she’ll go scouring for “evidence” that her way is the best way to boost her self-esteem and to make a little money.

maidmarian555

You don’t even need to have any level of medical or historical knowledge. It’s about empathy. If you care about women and babies that benefit from medicalised care, you can see the hatefulness in many of her statements. All you need is to be a half-decent human being to see that what she’s saying isn’t quite right.

BeatriceC

I’m another non medical person who’s knowledge has moved past the 80’s. Wanna know how I evaluate research? I zero in on the statistical analysis, since that *is* my area of expertise. Once I’m convinced there’s no shenanigans in the analysis (like data torture, poor study design, etc), then I’ll read the study. It’s amazing how much time I save just tossing out anything with bad statistical analysis. (Now granted, there might be some good info in some studies where the data was tortured, but more than likely not).

Empress of the Iguana People

The studies are mostly outside my skill set, such as they are, but I read history books and journal articles well enough to know not to trust Mother Nature!

nikkilee

This is a unique forum, full of conundrums. For example, there is no evidence to identifying health benefits of feeding formula (and some here have acknowledged that), and every piece of evidence that supports what governments and health agencies’ from around the world recommend about breastfeeding is rejected. For healthy, low-risk women, birth in a free-standing birth center attended by midwives is at least as safe as birthing in a hospital, and in some case, offers better outcomes. That is not accepted here. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-016-1208-1

maidmarian555

Because that is not the case in many, many individual cases. I have a big health benefit from formula feeding- the baby gets to eat and doesn’t starve to death. You don’t need to produce a study to show me my healthy, thriving son for that. Formula doesn’t hurt babies. It’s just another way of feeding those for whom breastfeeding doesn’t work. Want to respond to your completely incorrect list of formula ingredients that you invented and then a bunch of us went out of our way to repudiate? No? Didn’t think so. Also, I had a healthy, low risk pregnancy. As I’ve said many times, if I’d have waited for labour to start in a birthing centre, both my son and I would be dead. There is no one-size-fits-all solution for birth. Many things can go wrong. Women should be allowed to choose what’s right/safe for them without people like you trying to make them feel shitty for doing the best for them and their babies. Natural didn’t work for me. Doesn’t work for many women. Who are you, to criticise us for feeling thankful that medical solutions existed so that we are alive today? I refuse to feel bad that me and my son are alive today. Sorry.

Who?

One of the health benefits of formula is a fed baby, where mum can’t/won’t breastfeed.

The trouble with ‘in most cases’ at the freestanding birth centre is that there’s not always a crystal ball available to allow people to know which labours are going to go wrong.

The Bofa on the Sofa

I have explained the benefits of formula feeding for our family. A happy mom and $15k. You don’t think that leads to better health?

nikkilee

Evidence versus personal experience are two different things.

Heidi

Try answering the actual question asked.

Nikki Lee’s personal experience is evidence but everyone else’s personal experiences don’t count. (See her spiel about EDD not being accurate cuz her baby had vernix.)

nikkilee

Try reading what I wrote.

Heidi

I read what bofa wrote. He asked a very specific question and you totally didn’t answer him. You had three options basically: yes, no, maybe/don’t know. The platitudes about populations, not individuals and every variation on that are wearing thin, especially when they don’t seem to apply to you. Individuals absolutely do matter. I don’t know why answering in a straight forward manner is so hard for you.

The Bofa on the Sofa

No, her answer was pretty clear. She just couldn’t bring herself to say, “you are right. Formula was better for you.”

The irony, of course, is that she notes how our individual situation doesn’t apply in terms of the population level evidence, but then fails to recognize that in the exact same way, “the evidence” does not apply to individuals.

nikkilee

“Depends what evidence you are talking about. If you are talking populations, then my personal experience is only one part of a large picture.” Case studies are lower in the hierarchy of evidence; meta-analysis is the highest.

Individuals do what is best for them. Research outcomes look at populations.

Heidi

You replied to the wrong person.

Azuran

Indeed, individuals should be allowed to do that they feel is best for them. However, that requires that they receive proper information and education. Which you do not provide.

The Bofa on the Sofa

Individuals do what is best for them. Research outcomes look at populations.

How can what individuals doing what is best for them lead to worse results overall?

nikkilee

Best choices and best outcomes don’t go together.

The Bofa on the Sofa

Um, yes they do. Kind of by definition. The best choices are the ones that give the best outcomes. That’s what makes them the best choices.

Your problem is still that you are trying to apply population results to individuals.

If we had breastfed, that would have been a worse outcome for us, and therefore would have been worse for the entire population.

Azuran

Yea, they kinda do. The best choice is the choice that gives the best chance of the desired outcome to a specific individual.
And what is best also depends on the individual. Not everyone has the same goals and what is considered the best outcome for one isn’t the best outcome for another.

momofone

So, question:

My son was born at 38w3days due to placental degradation. His dad and I made the choice to deliver then because though we are not medical professionals, we had the impressions that placentas are fairly important. (It was also the recommendation of my clearly trying-to-get-to-the-golf-course OB.) He lived! In what way would you consider that a less-than-best outcome?

nikkilee

Technology being used for the right reasons is appropriate. Technology used routinely is not appropriate.

momofone

That is not what I asked.

Empress of the Iguana People

That’s the silliest statement I’ve read yet. And I read one sentence that said “You might have to tickle-tackle your dragon to get his socks on.” So, do you prefer to cut umbilical cords with your teeth or let your pet wolf eat it?

momofone

I see that you’ve responded to other posts since I posted earlier asking for a clear, direct answer to my question. Should I take this as confirmation that you cannot or will not respond?

Azuran

What does that even mean? Does that mean that you oppose the use or routine screening tests? How are you supposed to know there is something wrong if you don’t use technology to do routine testing and screenings?

swbarnes2

It means she is anti-hatting.

Juana

I guess it’s the same notion as with unnecesareans (sp?) – every CS where both mother and baby end up unharmed (or the baby gets out undistressed/alive) was unnecessary.

nikkilee

Routine screening tests, when used appropriately, are clearly useful. Like using an occult stool screening to see if a colonoscopy is warranted. When a pregnancy went nearly a month past the due date, using regular testing enabled me to make my own best choices. However, giving every single woman in labor an IV with pitocin in it, is not appropriate. What used to be done in an as-needed event has now become routine practice. Having seen physicians do dangerous things, such as wanting a multiparous woman having minute-long contractions every 3 to 5 minutes to be given an IV with pitocin in it is one example. Having working in the maternity care system for over 40 years, and teaching in it, and reading, is a foundation to make choices.The technology isn’t always helpful: there is just as much cerebral palsy now as there was before EFM became routine practice.

momofone

But it all comes down to risk and context, doesn’t it? With my family history, if my physician had stopped with the false-negative results of my occult stool test, I would be dead. Fortunately he knew to pursue more comprehensive testing based on both my report and my risk factors. I wonder how many things you have missed because of your aversion to the use of technology and your blind trust of nature. It’s frightening to think about.

By the way, you still haven’t answered my question. 🙂

Daleth

You are aware, aren’t you, that pitocin is given not just to assist or trigger labor, but to prevent PPH by helping an exhausted uterus contract sufficiently to stop bleeding? Or would you post somewhere about how terrible it was that I was given pitocin right after my c-section, when obviously with the babies out I had no need for a labor drug?

nikkilee

My comment was about the use of pitocin in labor.

Azuran

So I see that once again, you are just complaining against medicine in general. Despite not having any kind of proof that anyone is doing anything wrong.
No one is giving every single woman in labour an IV of pitocin. As for your claim of a doctor pushing pit on that woman: Probably there was a reason that you do not understand, as you have proven time and time again that you stick your nose in things without having the full picture
So I wouldn’t trust your ’40 years experience’ since you apparently still think today that it’s ok to tell total stranger that they shouldn’t follow medical advice even though you know nothing about them. That you say stupid stuff like ‘babies know when to be born’ and that you didn’t know induction reduces the risks of c-section until last week.
And apparently you think that cerebral palsy is the ONLY thing that EFM is supposed to prevent.

nikkilee

In my community, it is rare for a woman in labor not to receive pitocin. I know this because I teach hundreds of nurses from all the area hospitals every year and I ask them. In Mississippi, pitocin is not used routinely in labor, at least in the Hattiesburg region.

It is difficult to find what is the national rate of pitocin use in labor.

And you think that asking people how often pitocin is used is a proper way of measuring this? Especially asking nurses who are not the one making the decision, and probably don’t know why a specific case gets a specific treatment.

Clearly, you present yourself as someone who is against the use of modern medicine, you obviously have something against pitocin for example.
Your classes are not mandatory, People go to your class because THEY are interested in what YOU have to say. If they are interested in your class, it’s probably because they share some of your views. Meaning that they probably align more with your anti-medicine view than the average nurse. And it’s obvious that if someone thinks that pitocin is bad, they are WAY more likely to take notice of every single case that uses it and remember them more and dismiss and forget cases where it’s not used.

nikkilee

I ask the audience how often do they see spontaneous, unmedicated labors. My classes are mandatory for some facilities. Pitocin per se is neither good nor bad. Physiologically, it is different to natural oxytocin. It is how it is used that makes the difference, whether it is used routinely or not.

Azuran

I would expect that not many people get to see ‘spontaneous’ labour because women typically get to the hospital AFTER their labour started.
So yea, if you go to the hospital without actually being in labour, you either get sent back home, or you probably had an appointment for an induction/c-section.
You are again just being an hypocrite. You would be crying bloody murder if Doctors where deciding how to best treat patients by ‘asking the audience’. Why do you think it’s appropriate for you to do this?
and again: asking people their own experience, even if they are nurses, is in no way an adequate way to measure something.

But then again, if pitocin is neither good nor bad, why does it matter if it’s used routinely or not? You really make no logical sence

momofone

Is it your job to determine when it’s needed, or to order it for a patient?

momofone

I live in Mississippi, and could not be more dismayed to hear that you are “teaching” anyone here. We have enough problems without your adding woo to the mix.

nikkilee

Public health agencies in Mississippi feel differently.

momofone

Do they? Please provide documentation of that. Because the people I know who teach healthcare professionals are not fans of the Baby Friendly Initiative.

nikkilee

I was brought there to teach; hospital staff from at least 4 hospitals were there. I was part of an initiative that seeks to do something about Mississippi being at the bottom of most public health outcomes.

momofone

I fully support an initiative that does something about that. I do not support woo in the service of accomplishing improvement.

Daleth

The technology isn’t always helpful: there is just as much cerebral palsy now as there was before EFM became routine practice.

The reason cerebral palsy rates haven’t plummeted since EFM was introduced has NOTHING to do with EFM. It’s because extremely premature infants are surviving now who would have died before. Babies who would have died in the 1960s/70s/80s/even 90s are now surviving, albeit with CP and other neurodevelopmental disorders, because neonatal care has vastly improved since then.

If you stratify the CP rates by gestational age, or by birthweight (a good proxy for gestational age), you’ll see less CP in term and near-term infants, and far more in preterm and extremely preterm infants.

So actually the technology IS helpful. EFM helps prevent CP in term and near-term babies, and other technologies help preterm babies survive instead of dying.

nikkilee

According to the United Cerebral Palsy Research and Educational Foundation, 70% of brain damage that causes Cerebral Palsy occurs prior to birth, mostly in the second and third pregnancy trimesters. Twenty percent occurs during the birthing period while 10% occurs during the first two years of life while the brain is still forming. The industry has identified four key terms to help discern “when” the brain damage occurs.

Thank you for agreeing with me. Nice to know that you are retracting your initial claim that because rates of cerebral palsy haven’t dropped since EFM was introduced, routine EFM is bad.

I mean, after all, here you are admitting that 80% of cerebral palsy cases occur at a time other than labor (i.e., a time when EFM cannot possibly help), so rates of CP are pretty much irrelevant when it comes to telling us whether EFM is a good thing.

sdsures

You act like cerebral palsy is just one type – the worst imaginable. It’s not your fault, though – unless you have it or have a child who has it, all you know comes from the media, which tends to trot out the worst cases of CP that are confined to a mechanical wheelchair, can’t feed themselves, and have severe speech problems that are easily mistaken for developmental delay.

In reality, it’s a very wide spectrum, and some patients can have mild to moderate CP and still lead normal lives.

Empress of the Iguana People

Not screening until a month past due date? Are you nuts?

nikkilee

I didn’t write that clearly. I was screened several times a week each of the nearly 4 weeks after the EDC; NST and several biophysical profiles.

moto_librarian

But EFM has lowered the stillbirth rate. And I want to see proof that every laboring woman in the hospital is given pitocin during labor. I had none during my first labor – hell, I didn’t even have an IV.

nikkilee

Every year, I teach hundreds of hospital nurses from all the hospitals in my region. I ask them about spontaneous undisturbed labor, and labors without pitocin. They laugh and say, “Well if she comes to the hospital pushing, she won’t get pit.” There is regional variation in this practice; when I taught i Mississippi, the nurses there said that pitocin is not routinely given to laboring women.

Daleth

A handful of comments from your classroom every year, and you conclude that *in general* hospitals give pitocin to all laboring women? Seriously, if I posted a study with that methodology, you yourself would laugh at me, and rightly so.

nikkilee

It is far more than a handful, when 20 or 30 nurses in a class agree, and when these nurses are coming from every hospital in the region. Speaking to people who are doing the work, right now, has value.

Daleth

You said your classes contain hundreds of nurses. If 20-30 out of, say, 200-300 nurses all say that in their experience X is true, what in god’s name permits you to assume that it is true for the roughly, what, 80% of nurses who did not agree?

Hospitals involved in changing policy and practice (encouraged by the CDC, the Surgeon-General, ACOG, AAP, and APHA) mandate their staff to receive trainings. All healthcare professionals should have received 20 hours of breastfeeding education; the course I teach is just that, using an outline from BabyFriendly USA. Others choose to take my class. I have a mix of community and hospital workers.

momofone

So, again, largely self-selected.

Azuran

And all vets have this ‘joke’ about how orange cats are more likely than other cats to have urethral obstruction than other cats, and that they are more likely to have complication. Where did this come from? I have no idea. And I have never found any shred of evidence for this. But I’ve heard it being said at school, and by basically every vet I know agrees with this. Yet it’s based on 0 scientific evidence (and more than probably is not true)
It’s probably just a case of selection and recollection bias.
80% of orange cats are males. Urethral obstruction happens almost exclusively in males. Orange cats are rare, so you remember them more.

Speaking to people who are doing the work has 0 scientific value in how to make medical decisions.

And BTW, 20-30 nurses IS a handful. That is not in any way a statistically significant portion of nurses working in birthing ward. Even if we limit it to only your region.

MayonnaiseJane

OTish: How do I know if my ginger boy has an obstruction? Will he make a fuss? I think I’d notice genital irritation on my tuxy… he’s a shorthair and likes to clean his privates in the middle of the livingroom while holding eye contact (weird cat) but the ginger is longhair.

Azuran

Generally, cats with an obstruction will strain a lot. They keep going to the litter, stay there very long period of time, complain, strain and either don’t urinate or only urinate a few drops. (many owners actually mistake this for constipation.) They are also generally very uncomfortable, they will be moody or aggressive, hide, avoid contact etc. Grabbing them by the belly will result in very obvious pain.
Some times you can find little drops of urine (with or without blood) on the floor.
Some cats will lick their genitals more, but not all of them, and it’s generally not irritated or really visible.

Any male cat with any kind of urinary problem (blood, pain, light straining, urinating outside the litter) should be seen by a vet, as any untreated urinary problem can lead to an obstruction. If the cat is visibly straining, it should be seen ASAP as an obstructed cat can degrade very rapidly and die within 48 hours.

MayonnaiseJane

Gotcha… so as long as he’s still supper huggable, all is well. 🙂 Wait… does this mean that the chronicly wee-wee licking tuxy might be trying to tell me something? I mean he’s cuddly too… but… he does pay an AWFUL lot of attention to his little-pink-tick-tack.

Azuran

I don’t think I’d be worried if there is no visible irritation, he doesn’t have any urinary problem and it’s a behaviour that he had for a long time.
He’s probably just a little pervy 😉

MayonnaiseJane

That’s what my husband says. Lol. He doesn’t like the cat licking himself while staring at me. He’s all “Hey! That’s MY wife!!!” I kinda hope he’s not into me like that though… because last I checked he thought I was his mother, and that’d be really weird if he was into his mom. (I’m aware cat’s generally don’t think that. The ginger sure doesn’t but the tuxy brat was abandoned in the city park waaaay small and does that “suckling” on shirts thing…)

moto_librarian

You have no business teaching nurses anything.

fiftyfifty1

” Technology used routinely is not appropriate”
…types the woman on her computer …

nikkilee

Birth technology used routinely is not appropriate.

Azuran

You should be more specific. What birth technology? All of them? Some of them? What makes you an expert in deciding when they are appropriate? As far as I know, you aren’t a doctor.

The Bofa on the Sofa

Don’t you know? If a midwife can do it, then it is acceptable technology. If a midwife can’t do it, it is in appropriate.

Charybdis

Why is that, exactly? Does it somehow interfere with the Ancient Birth Mysticism BS the NCB/EBF folks espouse?

momofone

Who do you think should make that decision–patient, doctor, nurse, you?

Edited to add, just for the record, that I want ALL the birth technology if I’m the one having the baby.

nikkilee

In an emergency, the licensed health care provider. In normal circumstances, the mother and provider.

maidmarian555

So if you think it’s the mother and her provider’s choice whether to take advantage of ‘routine’ birth technology, maybe you should stop sticking your nose in and saying it’s “not appropriate” when used routinely. Also, define “emergency” when applied to appropriate use of a hormone drip. Because here it’s used for induction (only after every other method has been tried and failed) and failure to progress if a labour is going on way too long. How many hours should a woman be experiencing (SUFFERING) contractions (which may be erratic) and not dilating before a drip is administered? As I’ve said before, you can’t keep denigrating the ‘routine’ use of interventions and then dodge specific questions about what would constitute a ‘genuine’ need.

Azuran

And generally, the primary health care provider is the Doctor.

momofone

So essentially, you believe the person/people who should be making these decisions are the people who actually already ARE making them. Your problem is that they’re making different ones than you support.

fiftyfifty1

“Birth technology used routinely is not appropriate.”

Got it. If nikkilee wants to use a technology, it’s appropriate for routine use. If nikkilee doesn’t want to use a technology, it’s not appropriate for routine use. Doesn’t matter what the evidence shows or what other women may want or choose.

EmbraceYourInnerCrone

Humans especially in first world countries use technology for everything to improve their lives. Technology makes life easier and safer in everything from loading and unloading and tracking shipping containers, to improved methods for insulating and heating homes, to recycling, to testing and clinical trials for new medications and treatments. We live in homes that are cooled and heated and were built with technology. Technology is helping feed the 7 billion humans on earth(and technology is in large part how we ended up with 7 billion people) Technology helps find people after disasters and keeps them alive. Technology prints our books and transmits our data, and allows us to communicate with colleagues thousands of miles away.

All of us use “technology” all day every day unless we are living in a cave and eating only what we can catch ourselves.

Why should only pregnant women be forced to have technology rationed? Sorry I want the access to Rhogam, ultrasounds, tests for gestational diabetes, prophylactic treatment for Group B strep, C-sections for macrosomia, and breech and placenta previa and maybe twins. I want the monitoring of BP and quick treatment of pre-e and post-e. All the lovely advances in obstetrics means my daughters children maybe won’t die of the things that killed my mother and grandmothers siblings, mothers or sisters.

fiftyfifty1

“Case studies are lower in the hierarchy of evidence; meta-analysis is the highest.”

LOL, you have no idea what you are talking about. What evidence is “best” depends greatly. A single case study may be perfectly sufficient for some things (the classic Statistics 101 example is jumping out of an airplane without a parachute.) And of course where meta-analyses are concerned “garbage in, garbage out”.

Or you could try reading what other people have written. Many people here have given you firsthand examples of exceptions to your claims, which you discount with your populations vs individuals comments. You are so invested in breastfeeding being the supreme method of feeding no matter what that you are deaf to anything that contradicts that.

Azuran

Not in any kind of medical practice. Being a health care professional means being able to look at the data, then at the patient, and decide, between all the possible options, which ones are best suited to a specific patient.
There is NEVER a once size fits all in medicine. There is NEVER any option that is best for everyone.
You don’t push the ‘statistically’ best treatment. You tailor your care to every single patient in front of you, based on ALL the evidence

The Bofa on the Sofa

Depends what evidence you are talking about. If you are talking populations, then my personal experience is only one part of a large picture.

But if you are talking individuals, then my experience demonstrates unequivocally that formula feeding can be more beneficial than breastfeeding.

This is your problem. We ARE talking about individuals, and what is best for them. Just as in your “babies are born when they are ready” crap, you make generalities when we are talking about individuals. You could say, “in general, babies are born when they are ready.” But that means nothing to a woman who has a prime, or to the mother of a stillborn. Regardless of what happens in general, each pregnancy must be considered individually. As does each baby in feeding.

You would be wise to learn this guideline: all else equal, breast is better. But all else is never equal.

These are individual decisions made at an individual level. Population statistics mean squat.

nikkilee

“These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.

Heidi

Breastfeeding studies really don’t look at the whole population and they never will! Breastfeeding is very self-selecting. In the developed world, it’s always going to be the privileged-in-so-many-ways population that does breastfeed. In the developing world, we have issues of water contamination. Breastfeeding, if possible is better than feeding a baby contaminated water in those situations, and literally no one said it isn’t. But that still leaves moms who aren’t able to breastfeed (and those do exist and they are a sizable chunk of the population!) having to feed a baby with contaminated water and it still leaves women having to prepare food after 6 months with contaminated water. Babies still have poor outcomes in the developing world despite being breastfed. We’d do best by these people by providing them infrastructure. However, I didn’t notice you rah-rahing clean water. It’d save more children than breastfeeding.

There’s nothing in breast milk and the way it is consumed that makes it that much better than formula. It has antibodies, sure, but very few antibodies consumed orally do any good. That’s why most vaccines aren’t taken orally. The kind of antibodies that can be consumed orally are for GI illness and colds. But the nature of those kind illnesses is they mutate so quickly they don’t provide that much protection. A measly 8% reduction, which means multiple women have to breastfeed to reduce *ONE* cold among multiple babies, not to prevent one baby from ever getting sick. My antibodies for a cold I had in 1989 is unlikely to do much for a cold strain in 2017 or that diarrhea I had in 1992 probably didn’t produce antibodies that do much for a 2017 strain of random tummy bug.

And to say formula doesn’t offer health benefits is beyond dumb. You know it does. Would you seriously feed a baby with galactosemia breast milk? Would you seriously starve a child who didn’t have access to breast milk?

nikkilee

There are no studies showing that babies receive health benefits from formula feeding. Industry can’t do that. Classical galactosemia does require that a baby be fed formula; depending on which study you read, this happens in 1: 30,00 to 85,000 births. Duarte’s galactosemia would allow for some breastfeeding, along with regular clinical monitoring. Formula was designed as emergency replacement feeding when it was invented in the 1860s; a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread). The impact on the environment is another problem with the globalization of formula. Formula manufacturing, packaging, transportation, and trash are environmentally costly. Breastfeeding itself is a sustainable process, leaving no carbon footprints. Pumps are environmentally costly. Another conundrum to be solved.

The Bofa on the Sofa

There are no studies showing that babies receive health benefits from formula feeding.

Yeah, because all else equal, breastfeeding is better.

But that does not tell us much when all else is not equal. As in, always.

These are decisions made by individuals according to their individual situations. They are not basing it on what is better for everyone else, but on what is best for them.

You have a problem with that.

Heidi

Because moms don’t eat right? And when they do eat their *extra* calories, you can guarantee it’s in a highly sustainable way? Surely, they wouldn’t be relying on convenience foods, like maybe UHT milk cartons or prepackaged yogurts or nuts, or anything like that on a nearly daily basis, especially if they lead busy lives? Requiring more calories, and likely a prenatal vitamin and/or a vitamin D supplement, is going to have a negative impact on the environment. Don’t try to deny thermodynamics or do if you want to further make a fool of yourself. And do you ever recommend supplements to aid in lactation, such as fenugreek or whatever? I saw you gladly gave an interview/shout out for yourself on Motherlove, a company that peddles supplements that most likely do not work at all. Are you concerned about the impact that producing those have? Get back to me when you’ve actually done all the analysis for this.

And the fact you’d even suggest breastfeeding with Duarte’s galactosemia shows how unreasonable you are. We aren’t going to do a study on infants who we know shouldn’t consume breast milk to prove to you formula has health benefits. It would highly, highly unethical to breastfeed a baby who can’t metabolize lactose. It should never happen!

As for herbs, I don’t recommend them as I don’t know about them, and there are associated risks. When moms want them, I refer to the licensed herbalists who practice in my state.

Heidi

“Because available data about the neurodevelopmental outcomes of children with Duarte variant galactosemia are conflicting, further studies are warranted to determine what long-term outcomes are and whether the dietary intake of galactose in the first year of life influences outcome.”

If it was me, I’d much rather play it safe than sorry.

fiftyfifty1

“As for herbs, I don’t recommend them as I don’t know about them, and there are associated risks. When moms want them, I refer to the licensed herbalists who practice in my state.”

And let me guess, the herbalists refer to you when a client “needs” crianial sacral therapy!

Heidi

At least if she “prescribed” herbs, she could be a one-stop shop for all your quackery needs and would reduce vehicle carbon emissions. Obviously, she’s not that committed to environmental causes.

swbarnes2

If you are referring people to non-evidenced based practitioners, encouraging them to spend money on unregulated shit that does not work, that reflects on your honesty Badly.

nikkilee

Folks that are licensed by the state have passed an exam validating a basic level of safety.

Azuran

ohhhh basic level of safety. That’s SO reassuring. Let’s not forget, some CPM are also licensed at a state level…..and we can see what that’s worth.

nikkilee

In most countries with better maternal survival rates than ours, most of the births are attended by midwives, and a physician isn’t in the room. But then, those countries have socialized medicine, so that is another helpful factor.

Yes, some states license CPMs. Their state licensing boards have deemed this safe.

The Bofa on the Sofa

Yes, some states license CPMs. Their state licensing boards have deemed this safe.

But it isn’t. Ask Oregon, where, IIRC, CPMs are licensed, and their outcomes are poor.

Your “basic level of safety” is nonsense. Then again, we know that because “basic levels of safety” are not “validated” by stupid exams.

An exam would be considered a _minimal_ level of safety, but nowhere near sufficient for any practice.

nikkilee

Physicians are licensed by the state. Licensing attests to the person being educated enough to be able to practice their profession safely.

The Bofa on the Sofa

Licensing attests to MINIMAL competency.

Doctors aren’t capable and good because they are licensed.

Azuran

Indeed they are. But not all state license are equal.

In order to be a vet, I had to go to university for 5 years (no other option, no internet class, no correspondence class, no ‘following a vet’ for a month or two, we have only 5-6 vet school in my entire country, it was one of those or nothing) And most teachers in those school where actually board certified specialists.
Then I had to pass a certification exam. And we are not talking a ‘state’ level exam. It’s a North American exam. Every one in both canada and the USA has that same exam, can’t pass it, can’t be a vet.
And then I have to register to the professional order. I am then required by law to attend a minimum number of approved continued education programs every single year. And the professional order does regular inspection of my work and my clinic. Any disciplinary action against me or any other vet is public. Anyone can call the order and as if I’ve ever been found guilty of anything. If I’m banned from practice, I can’t go to another place and just start over again, the order won’t allow it.

Next to that, CPM do what? Internet classes, correspondence classes. Follow another midwife for 10 births. And the people who give those classes are other CPM. And if things go south, they move next state.

CPM licensing is a joke. I wouldn’t trust them with a pet rock.

nikkilee

I don’t know of any licensed practitioners that don’t have to take some form of continuing education. CPMs have to have education, practical experience and a licensing examination: the same as any licensed worker.

Azuran

Maybe they do, but since their base education is shit, so is their ‘CE’
To be honest, medical professional are licensed on a state level for administration purposes. What tells you much more about what their licensing is worth, you have to look at the recognition outside of the state.
I’m licensed in my province. BUT, if I decide to, I can more to any other province, any state in the USA, and even some other countries in the whole, and my certification is still recognized and I can practice there.
The same goes for doctors. They can practice anywhere in the country, they can practice and are recognized for their skills in many other countries as well.

As for CPM? Their accreditation is so worthless that it’s not even recognized between states of the same country. It has 0 recognition anywhere else in the world. If a CPM tried to come to Canada, we would laugh in her face. Even third world countries don’t want them.

Daleth

CPMs are licensed, in the states where they are licensed (about half of US states), because they lobbied the hell out of those states’ legislatures. That’s how laws get passed. I speak as a lawyer from a very politically active family.

Legality does not equal safety any more than illegality equals lack of safety. Or tell me, did recreational marijuana suddenly stop being dangerous in Colorado and Washington, while remaining dangerous everywhere else? Or for that matter, are CPMs safe in Oregon but unsafe in Pennsylvania?

momofone

So then when licensed physicians use technology in providing prenatal care and assessing fetal and maternal health, they’re (to use your words) “educated enough to be able to practice their profession safely.” I’m sure that must be a huge relief for you!

Azuran

And yet, their own stats show that their CPM have a death rate much higher than hospital birth. Their accreditation isn’t worth shit.
Oh, so, you just decided that it was because of the midwives that in SOME other countries, the maternal death rate is lower. Do you have some kind of actual study for that? Because between socialized medicine, better healthcare, probably lower rates of risks factor such as obesity, diabetes etc etc, midwife care is probably not the lifesaver you think it is.
Especially when anyone with half a brain can understand that midwives in those places only take care of low risk women, and will bump anyone with any kind of complication to an OB. So of course, any death that will happen will happen under the care of an OB.

And how about when a home birth midwife not only accepts a patient with a history of preterm labor, a cerclage, and thyroid problems, but encourages her to deliver a premature baby at home, and refuses to take her to the hospital when she asks? And the baby dies as a result?http://hurtbyhomebirth.blogspot.com/2011/03/thomas-story.html

Those are just a few examples I found in less than 5 minutes on google.

Please tell me you now understand that in fact NO, in the US, home birth midwives do NOT “take care of only low risk women.”

Handy list: Let’s count the risk factors there:
1. Multiple pregnancy
2. Post-dates (41 weeks is VERY post-dates for triplets, which is quite dangerous since placentas tend to fail earlier in multiple pregnancies)
3. For the triplet mom, no prenatal care–they didn’t even know she was carrying triplets, they thought it was twins!!!!
4. VBAC holy shit excuse my language but HOLY SHIT, these midwives agreed to assist in a post-term HBAC of a multiple pregnancy! Even an uncomplicated full- or slightly pre-term VBAC of a singleton baby carries an approximately 1/200 risk of death to the baby. Make it twins and the risk more than doubles (each baby has 1/200 risk, so with two babies the total risk is 1/100, and having more than one baby in the womb increases the stress on the womb and thus the chance of uterine rupture–which is what kills babies in VBACs).

Azuran

You know, majority means 50%+1. It really means nothing
Did you even read those stats?
2-10% of mothers have GD.
6-8% have high blood pressure
3-5% have preeclampsia
1% is over 40.
So, from those numbers alone, it’s pretty safe to estimate that 10-15% of pregnant women will have at least one of the condition listed above.
And that doesn’t include breech or women with previous c-section. It also doesn’t include women with preexisting condition like hearth problems, obesity, non gestational diabetes.
Sure, the ‘majority’ of women (as in, more than 50%) followed by OB are low risks. But a very significant portion (at least 1/10, more than big enough to be statistically relevant) are higher risks.

I could just look at the pregnancies in my clinic since I’ve started working.
In the last 3 years we had 13 pregnancy. Of those 13 pregnancy, 5 were high risk for a variety of reasons. So yea, you could say that the majority of the pregnancies at my clinic are low risks, it’s true. But that’s a little hypocrite when 38% of them where high risks. But hey, thanks to medicine, 100% of those babies where born healthy.

moto_librarian

Try doing some research on the demographics of the birthing population in the U.S. We are as a whole heavier, older, and more prone to preexisting health conditions that used to preclude pregnancy. One of the leading causes of maternal death in this country is cardiac problems.

CPMs are a joke. Their boards are more interested in promoting the “sisterhood” than actually ensuring safe practice. The credential should be abolished. If you want to be a midwife, put your big girl panties on and become a CNM. If that’s too hard, you don’t deserve to be in the profession.

nikkilee

Here’s the top 10 percentages of maternal death, from the CDC 2011-2013.

Hemorrhage, pregnancy-related hypertensive disorders and infection are among the top causes of death in both the United States and the developing world.

The vast majority of these women are dying after hospital care given by physicians.

CPMs reflect a different philosophy of education, and an equally valid education. We disagree.

moto_librarian

You are willfully ignorant. 30% of deaths are related to cardiovascular or non-cardiovascular diseases. Midwifery care would not save these women, and it’s fair to say that more would die as a result. The same can be said for AFE, pre-eclampsia, HELLP, and cardiomyopathy. Women in the developing world die of pph because they do not have access to anti-hemorrhagics and blood transfusions. Infections occur after vaginal birth as well as CS.

CPMs are an insult to the expertise, education, and training of midwives everywhere. It’s unfortunate that you are too blinded by your own ideology to see that.

momofone

Specifically what “equally valid education” are you referring to?

nikkilee

What experts at state licensing boards decide.

Azuran

I doubt they think that CPM education is ‘equally’ valid as that of CNM or OB.

momofone

No, that’s not the question. What education, specifically, do you mean? High school diploma, bachelor’s level, master’s level, doctoral level, other?

Dr Kitty

When it comes to CPMs and we’re talking about someone who may or may not have a high school diploma, “expert” is a stretch.

Azuran

‘The vast majority of these women are dying after hospital care given by physicians.’
Well DUH. of course they are. It would be insane if anyone BUT an OB was following there women. That’s why they are risked out of midwife care you idiot.
That’s like saying that ICU have one of the highest rate of deaths of the hospital department. DUH it’s the ICU, basically everyone who is at risks of imminent death goes there.

Guess what, the more time I spend personally giving care and monitoring my patients, the more likely they are to die. Now an idiot like you might think that I’m killing my patient. But an intelligent person would understand that I’m going to trust my technicians with most of the care needed by my stable, not dying patients. While I’m going to personally take care of the unstable ones who have a very real risks of dying very soon.

nikkilee

The majority of women seen by OBs in hospitals are healthy low-risk women.

Azuran

And the low risks women are generally not the ones dying. Do you have any kind of proof that CPM care have LOWER death rate for low risks women than OBs caring for low risks women? Of course you don’t, because it’s actually HIGHER.
But we’ve already talked about how ‘majority’ really means nothing. As I pointed out, the majority of the women at my clinic had low risks pregnancy, despite the fact that 38% where high risks. But once again, you decided not to answer, as you generally do when someone points out your false argument.
Care to also comment on that study about obesity in Chinese babies and how the study actually said the exact opposite of what you said it did?

Azuran

Again: Define ‘majority’
As I pointed out twice already. The ‘majority’ of women at my clinic where low risks. But 38% where sill high risk.
Majority is 50%+1

corblimeybot

You’re really bad at calculating percentages and ratios and all that. Just abysmal. I thought I was crappy at math, but at least my shitty math skills aren’t incorporated into the healthcare of others.

kilda

yes, and in those countries the midwives have a much higher level of training that a CPM in the US has. US direct entry CPMs would not be considered qualified to practice midwifery in ANY of those countries.

swbarnes2

Your dishonesty shines through again. Selling sugar pills and water is “safe”. But not medicinally effective.

Do you tell your patients that you know you are sending them to practitioners who are going to charge them for things that don’t work better than sugar pills?

No, because you are dishonest.

sdsures

What’s wrong with UHT milk? My husband and I keep it around for emergencies when we’re unable to go grocery shopping because of low energy levels.

Nick Sanders

It comes in a box. That’s just wrong.

sdsures

In Toronto, milk comes in bags. The horror!

Azuran

XD I’ve never understood why people are so freaked out by our milk bags

Nick Sanders

Because it looks like a recipe for milk getting spilled everywhere all the time.

Azuran

It really isn’t. Bags are super sturdy, I’ve never broken one. And we have pots to put the bag in to serve the milk.

MaineJen

….”milk bags” *giggle*

sdsures

Dunno. Guess I’m just a weird Winnipegger.

Nick Sanders

And not just any milk, homo milk! Won’t someone please think of the children?!

Heidi

I want my milk to separate within seconds of shaking it while I’m trying to drink a glass personally, or while I’m trying to eat a bowl of cereal, it’d be fun for the fat to be floating to the top.

sdsures

That made my British husband chortle when he saw that.

Heidi

Nothing is wrong with it! I keep it because you don’t have to heat up milk to make yogurt. But it can’t be recycled in the US and Nikki is pretending she cares about that kind of thing.

corblimeybot

I am still very annoyed with a lactation consultant who convinced me to take megadoses of fenugreek. It’s not just that it doesn’t work. It’s also that she didn’t check my OWN health situation at all before she told me to take huge doses of unregulated supplements.

Ex: I have asthma, and fenugreek can worsen asthma. i had also had severe preeclampsia with organ involvement just a week or two before this LC appointment. Yet she wanted me to take some gigantic amount of unregulated herbs, despite that I was recovering from systemic damage to my entire body.

Heidi

All fenugreek did for me was make my armpits smell like vomit pancakes! I took it entirely on my own, even figuring that it probably doesn’t work and knowing supplements aren’t regulated. I just had to see for myself.

corblimeybot

You’re right about the awful pancake stench. It was NOT pleasant!

Heidi

Nothing to do with lactation, I’ve noticed the new fad with deodorant lately is food scents, like macaroons. I seriously don’t get it!

corblimeybot

Ewwwwwww!

nikkilee

An unsafe practice. . . .fenugreek can interfere with the absorption of prescription medication.

moto_librarian

No shit. My LC told me to use it too, and I’m a severe asthmatic. Your whole profession is a joke.

MaineJen

Babies definitely receive benefits from not starving when their moms (can’t/aren’t able to/don’t want to/none of your business) breastfeed. I would think that would be self-evident.

Daleth

There are no studies showing that babies receive health benefits from formula feeding.

Actually that’s not true. The discordant siblings study found only one health difference between breastfed kids and their formula-fed siblings: the breastfed ones were slightly MORE likely to have asthma.

a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread

FYI the past tense of “to lead” is not “lead,” it’s “led.”

nikkilee

The discordant siblings study had a detailed analysis of everything except the definition of breastfeeding, which was “Yes or no”. . . .no analysis of duration or exclusivity. Big flaw. Too bad, because if the authors had done that, it would have been a landmark study.

swbarnes2

“Table 5 presents findings from a set of analyses that are identical to those presented in Table 4 except the independent variable is breastfeeding duration (in weeks) as opposed to breastfeeding status (yes/no). Taken as a whole, these results reveal the same patterning as was evident in Table 4, whereby estimates of the effect of breastfeeding on a diverse set of childhood outcomes are substantially attenuated toward zero when we rely on sibling comparisons.”

No where in this study is there a chart or table of how many kids breastfed, how many were breastfed exclusively, and what was the breastfeeding duration. There are only these two tables reporting on those data, and conclusions based on those tables. A big question about breastfeeding data is unanswered. Very interesting that this is left out.

Here’s some examples of what that sibling study should have included in their paper:

Main outcome measures of the original PROBIT study were: “Duration of any breastfeeding, prevalence of predominant and exclusive breastfeeding at 3 and 6 months of life”.

A study from Greece in 2014 stated this: If women initiated breast feeding, further information on breastfeeding intensity and duration was asked, as well as information regarding the first time they breast fed their infant and the duration of breast
feeding. Duration of breast feeding was categorised as ‘never’ breast fed, breast fed for ‘1–6 months’ (according to WHO recommendations) and breast fed for ‘>6 months’. Breast feeding was also categorised according to the WHO breastfeeding
definitions as exclusive, predominant and complementary breast feeding.”

One of the studies based on the Harvard Nurses” study (Steube 2009) described breastfeeding this way:

In 1997, participants completed a detailed questionnaire on breastfeeding and use of medication to suppress lactation for
each of their first 4 children. Women with more than 4 children reported total months of breastfeeding across all additional pregnancies. All durations were reported as categorical variables. For assessment of total duration, women were asked, “If you breastfed, at what month did you stop breastfeeding altogether?” For assessment of exclusive duration, women were asked, “At what month did you start giving formula or purchased milk at least once daily?” and “At what month did you start giving solid food at least once daily (baby food, cereal, table
food, etc)?” Exclusive duration was defined as the earlier of these 2 time points.”

There is a big hole in the sibling study.

swbarnes2

You said they didn’t study duration of breastfeeding. That was a lie, end of story. You lied because you are dishonest. You can’t get around that.

The cold truth is that at best, the benefits of breastfeeding are utterly dwarfed by benefits from better socioeconomic status. You are too dishonest to accept this.

Daleth

I agree that better definition would be ideal. However, by definition in the discordant siblings study all kids who were exclusively or primarily breastfed fell into the “yes” group, and the only ones in the “no” group were the exclusively formula-fed kids. Don’t you find it interesting that thousands of exclusively formula-fed children were indistinguishable, healthwise, from ones who got anything from “any amount of breastmilk sufficient for mom to remember it 4 years later” to “exclusive breastmilk”?

Or I should say, indistinguishable except that they actually had lower rates of asthma.

Sue

“Formula was designed as emergency replacement feeding when it was invented in the 1860s; a combination of factors (the rise of industrialization, two world wars, the rise of science and corporate influence) lead to its spread). ”

Nope – wrong again.

Breast milk substitutes have always been known. “Formula” just means “recipe”. It included everything from goats’ or cows’ milk with sugar added, to tinned condensed milk, to rice porridge.

Sure, mass manufactured baby formula came with industrialisation, as did mass manufacture and supply of a huge number of products.

Sue

“There are no studies showing that babies receive health benefits from formula feeding.”

Nonsense.

There is a huge natural experiment – historically – babies who could not be breast fed just starved. Those who were fed a breast milk substitute didn’t starve.

It’s hard to imagine doing a prospective trial – would you advocate intentionally allowing babies to starve to show that the fomula-fed did better? What a bizarre idea?

sdsures

Populations in any research cannot be studied as a whole; it’s impossible because a population is defined as every single participant in existence. That’s why we work with samples.

The Bofa on the Sofa

“These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.

You disagree?

fiftyfifty1

“”These are individual decisions made at an individual level. Population statistics mean squat” to the individual. The theme of this forum. Thanks.”

You have a problem with that? What can population statistics do anyway beyond give a person a hint about what *might* be more likely to turn out well for them?

Studies show that MOST people do best with ~7.5-8 hours of sleep. But I need closer to 9. Should I choose what is healthiest for the average person and walk around chronically sleep deprived?

Studies show that in general children do best when they are given books at grade level. Should gifted students be made to read books too easy for them because they match what grade they are in? Should students who are struggling to read be made to choose books they have no chance of decoding?

Studies show a glass of wine a day prevents heart attacks. Should alcoholics and Mormons be berated into drinking?

Come on nikkilee, you said you were all about individualized care.

Dr Kitty

Nikkilee if formula feeding leads to money in the
bank, sleep for the parents and a baby who thrives, it beats breast feeding.

Which is the outcome for healthy, low risk, PAROUS women and is only applicable because composite outcomes which make TTN equivalent to intrapartum stillbirth were used (both coded as “serious adverse events”).

Forgive me, but 3 days in NICU without long term adverse effects aren’t equivalent in the real world to the death of your baby during labour.

Like I said- the people who comment here know how to evaluate research.

Frankly, I don’t expect much from someone who has to be prompted to seek evidence updating SIDS information she got 30-odd years ago…

nikkilee

The links from 2011 and 2016 (AAP) didn’t count.

Heidi

Galactosemia is one glaringly obvious situation where formula offers a lifesaving health benefit. There are also other situations where formula is better for a baby than breast milk. Some babies with soy and milk allergies cannot even drink breast milk without suffering. Even if mom eliminates them from her diet, the baby must eat formula for a few weeks until soy and dairy has left mom’s system.

maidmarian555

I have a friend who’s baby was allergic to eggs, dairy and soy (amongst have other things). She managed to follow a restrictive diet and breastfeed. You know what she called it? (Keeping in mind she was also vegetarian at the time). Hell. She called it hell. Said she’d never recommend in a million years that any other woman do what she did.

Heidi

That sounds like hell! I can’t imagine having the time or energy to read every label for offenders and having to prepare everything from nearly scratch when life is already so hectic with a baby. Then I’m sure you still worry that you accidentally ate something bad for baby.

maidmarian555

Poor little thing was in and out of hospital for his allergies continuously for his first year. He shook off the soy allergy eventually (thank Christ) but if that’d been me I couldn’t have done what she did. She wouldn’t recommend it either. There are special formulas designed for what she went through. I’d have been all over that.

Heidi

I wonder if my younger sister had some sort of allergy or could have benefited from some kind of specialized formula. My mom breastfed her, she latched just fine and my mom felt like she made plenty with her.my mom thinks she made “skim milk.” I don’t know if making too low fat of milk is a common problem. Anyway, she kept losing weight so my mom switched to formula. The pediatrician was relieved since she was a failure to thrive. But then with formula she would spit up entire bottles. She looked so pitiful for months. This was 1995 so I’m not totally sure what the formula choices were but soy was also tried to no avail. Things did get better with time but they were considering surgery for reflux but I feel like I’ve read that option has fallen out of favor. I was only 10/11 years old but even I remember being so worried about her.

maidmarian555

Yeah nowadays there are way more options. And things to examine if a baby isn’t thriving. I’m not particularly convinced by the ‘crap milk’ theory, often peddled by lactivists so that women will blame themselves rather then look into allergies. I’ve had issues with dairy causing eczema for years. Apparently I rejected cows milk and other dairy products as a baby for a number of years. Idk how well I trust my mother’s assessment but it makes some sense that I wouldn’t drink milk as a child when I know it gives me rashes now. There are other children in my family with quite severe lactose intolerance so it does make sense.

Heidi

The choice of formulas is a great thing. My husband’s cousin’s son needed hypoallergenic, hydrolyzed protein formula. She was not able to breastfeed. He went from being inconsolable after eating to perfectly fine with nutrimigen and zantac. I am not sure how nikkilee can claim that isn’t a tremendous health benefit.

fiftyfifty1

Your link is ridiculous and you know it. It’s a study in Denmark where they compared freestanding birth centers to hospitals, and found that the birth centers were indeed safe for strictly risked out women. But it just so happens that these “freestanding” birth centers were actually located *immediately adjacent* to hospitals with full anesthesia and ICU services. And of course they were staffed by real, hospital trained, midwives (the equivalent of CNMs in the US).

When you use this paper to convince your clients that out of hospital birth is “safe” do you reveal to them that this situation bears absolutely no resemblance to OOH birth in the US where you practice?

Amazed

Now, she’s going to tell you that everyone has to make a living. Clearly, it’s totally fine for her to lie to her clients, as long as she gets to make money from it.

nikkilee

There are 2 free standing birth centers in my region, staffed by CNMs.

And if they are staffed by CNMs and nothing but CNMs, and they are located immediately adjacent to a hospital staffed 24/7 with ICU and anesthesia, and the CNMs have privileges at that hospital, and the records are integrated, and the women are rigorously risked out, then you can tell your clients that the Danish study applies to them. Otherwise you aren’t giving them the info they need to make an informed choice.

Roadstergal

You’re shockingly good at missing the point. It’s a rare skill to do it so smoothly and consistently.

momofone

I think it comes from lots of practice.

yentavegan

But do those Free standing Birth centers have seamless transfer of care procedures? Do those free standing birth centers employ CNM with hospital privilege?

yentavegan

Vylette Moon’s mother thought she was getting the best of both worlds when she chose a Free standing Birth Center staffed by CNM’s. Read her story on Justice for Vylette Moon facebook page….

Azuran

And no one is saying that birth centres with properly trained midwives shouldn’t be handling low risk women.
However, first of all, the woman has to WANT to use midwive. (Which is a minority of women, you might not like it, but that’s the truth)
Knowing who is low risk enough also requires medical knowledge that you obviously lack.
Lying to women about their risks factors is malpractice.

Empress of the Iguana People

I’m kind of glad to be old, fat, and with a history of scarlet fever (though apparently it didn’t hurt anything by my ear) Only the Sooper Sertifyed MidWives would have not risked me out. My BP was perfectly fine until 4 hours into my first labor.

MaineJen

Yawn. Midwives have better outcomes *because* they treat low-risk women only. As soon as they start not running tests for fear of risking their potential patients out (I’m looking at you, American CPMs), their bad outcomes skyrocket. Look at Oregon.

sdsures

Selection bias, right?

Daleth

For healthy, low-risk women, birth in a free-standing birth center attended by midwives is at least as safe as birthing in a hospital

Actually no, birth in a free-standing birth center is twice as likely to kill your baby as birth with hospital midwives. That is better than home birth, though, which is about four times more likely to kill your baby.

Or did you not read the study out of Cornell that looked at ALL births of low-risk babies in the United States over a 3-year period (over 10 million babies)?

Dr. Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, and co-author of a study used in the report has already written a response to the journal saying that the data was misconstrued—and that this “is a politically motivated study.”

The neonatal mortality rate for full-term birth is very low (a few per thousand at the most). It’s difficult to calculate rare events unless there are massive numbers because even one event in a small group will artificially raise the rate. A meta-analysis allows a researcher to combine many studies in order to get a larger data pool, but meta-analyses are prone to error when the groups are too small or are too dissimilar.

A good analysis uses data sets that are consistent for what they are supposed to represent. In this case, a homebirth vs. hospital study should only contain the single variable of location. Other parameters should be consistent for each study included in the meta-analysis. The births should be considered low-risk. The births should be planned to occur with an attendant. The attendants should have similar training or emergency equipment. The locations should have similar travel times to similarly equipped hospitals. And the studies should take place during similar time periods.

A good meta-analysis comparing low-risk homebirth to low-risk hospital births would not include unattended births, unplanned homebirths or high-risk homebirths. And it would compare rural homebirths to rural hospital births, not to urban hospital births.

Daleth

Thank you for your views on meta-analyses. Not sure why you went to the trouble of writing all that down, though, since the Cornell study WAS NOT A META-ANALYSIS.

Also, thank you for your views on studies in which sample sizes are too small to draw accurate conclusions. But again, not sure why you shared those views, since in a study that seeks to compare the relative safety of home birth vs. hospital birth in a given country, it is literally impossible to have a LARGER sample size than “every single baby born in the entire goddamn country, except we left out the high-risk ones so that we could be sure we were comparing apples to apples.”

And that of course was the sample size used in the Cornell study.

Why are you wasting your breath by criticizing unidentified other studies that used different methods, instead of talking about the study that we’re supposed to be talking about?

swbarnes2

Did you guys catch that the reason Nikkilee is talking about meta analysis is that she didn’t write any of that herself? She plagiarized it from Midwifery Today about another study. Nikkilee is fundamentally dishonest. Lying is like breathing to her.

Daleth

Or she’s just not interested in thinking for herself or questioning any aspect of her quasi-religious faith in home birth, midwifery etc. She’d rather just spout the party line. Oh well.

Roadstergal

OMG, that’s the perfect parallel. This is like the Nicene Creed to her. “Breast is always best, formula is poison, unmedicated vaginal birth is our lord and savior.”

Empliau

I don’t care about a mortality rate of a few per thousand if my baby is one of the few. And by the way, what is the rate of morbidity? If at a free-standing birthing center that is not part of a hospital complex I or my baby should have a complication that needs an OB, a c-section, or some other intervention (transfusions in case of severe hemorrhage, for example) and it’s not available, the rate is 100%. I consider that utterly and completely unacceptable. To lose a child or to have a child with disabilities that could have been avoided by skilled medical care could never be worth it to me. To bring up a child without me could never be worth it to my husband.

You are very dismissive of the dangers, but in this community there are many women who were low risk until something went south. It happens, and the doctors and CNMs here have made it clear that it isn’t rare. Luckily most of the women who post here who have needed skilled or emergency interventions were at hospitals with competent medical professionals.

My professional field is the ancient world. Archaeological finds and historical evidence are unequivocal: childbirth is bloody goddamn dangerous for both parties. Yes, things have improved. They have improved because of medical science. Why people with access to these lifesaving techniques would deliberately gamble that nothing will go wrong with their and their child’s health, brain, and very life is simply beyond me.

nikkilee

Trouble is that skilled medical care also carries risks. This is how medical malpractice attorneys make a living. Life is risky; there is no way to guarantee the outcome that we want. We can do only our best.

swbarnes2

So you have nothing to say about how dishonest, not to mention stupid, it is to plagiarize a response that isn’t even relevant to the discussion? Is it because you sincerely do not understand why lying is wrong?

Who?

Maybe nikkilee is all about alternative facts?

Heidi

Trouble is that riding in a car with a seat belt also carries risks. This is how car wreck attorneys make a living. Life is risky; there no way to guarantee the outcome we want. We can only do our best. And best is not wearing a seat belt, right?

Who?

So what, just choose nothing because then it can never be your fault? Stumble through life sighing about bad luck and crowing about good luck? And quietly burying the bad luck stories which would be bad for business.

Nick Sanders

That’s what comparative risk assessment is for.

MaineJen

Doing our best doesn’t mean throwing caution to the wind. Doing our best means availing ourselves of every possible opportunity to make the experience safer.

I’m very short, and I have to pull my seat close to the steering wheel when I drive. If I’m in an accident, there’s a chance I’ll be injured by either the air bag or the seat belt (if I can’t adjust it low enough). Does that mean I drive without a seat belt, in a car without an air bag? Of course not. I don’t obsess about how unsafe my airbag is; it’s there to save my life if I’m in a catastrophic accident.

Skilled medical care is there to save your life, too. I consider myself very fortunate to live in an era of air bags and seatbelts, AND pitocin and continuous fetal monitoring.

Sue

“Skilled medical care also carries risks”? Of course, but much smaller risks than the absence of skilled medical care. Clearly.

Wearing seat belts also carries risks – but tiny risks in comparison to those it mitigates.

Azuran

Except that the risk from skilled medical intervention is much lower than the risk of CPM care, which is basically: can’t do anything but look and transfer if anything is wrong.
The reason why malpractice attorneys aren’t making a living out of CPMs is because CPMs do not carry medical insurance and therefore cannot pay up when they are sued. So it’s a waste of time.

Empliau

Good. Exactly. Now, what are you risking? In a hospital, the biggest “risk” seems to be an unwanted CS and hurt feelings. (I except people like Erin, who have suffered genuine trauma. Erin, I’m so sorry they treated you that way.)

I am in the U.S., and when things go south in the hospital and a medical professional was negligent or otherwise at fault, insurance will compensate a family for loss and subsequent necessary care. CPMs in freestanding birth centers don’t have such insurance – so, if your baby suffers HIE or other damage, well, they wash their hands of you with blather such as you just said above.

Finally, some of the hospital malpractice claims come from home birth/birth center births that they shoved off on the hospital when things went sideways. Thanks loads! Way to take responsibility for the risk!

Sorry about the sarcasm. Pious platitudes like Nikkilee’s above set my hackles on stun.

How about you pay attention to what people are telling you about why they DON’T choose home birth?

Azuran

How about looking at why >99% of people DON’T chose homebirth.
Risk itself doesn’t depend on your point of view. The risks of something doesn’t change. What change is whether or not you’d prefer to face risk X or risk Y.
If you’d rather face the much higher risks of homebirth than hospital birth, that is your right. But it doesn’t make home birth safer. You just preferred which which you’d rather take.

And define ‘iatrogenic prematurity’ because the only time a baby is induced prematurely, it’s because of health reason. Those don’t happen because anyone felt like it.

Conclusions. Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions

Before the latest ACOG recommendation and the March of Dimes campaign to stay pregnant for 39 weeks, women were induced because doctors told them “you’ve been pregnant long enough” or because it was hot out and the mother was uncomfortable, or because her mother was available to help for only a particular week. I heard these stories from the women I cared for as a maternity nurse..

Azuran

And what you linked does not provide any information about the reason for the induction­ or c-section. So it doesn’t mean anything.
And you also might want to look at the outcome.
Who cares if mothers want to be induced for whatever reason if there is no negative outcome (or if the woman CHOOSES to take that risks?)

momofone

If your doctor wants to induce you because “it’s hot out” (which, by the way, is BS, but I’ll play along), and you don’t want to be induced, guess what you can do–you can say no. If your mother’s availability is not a consideration for you in being induced or scheduling a c-section, you don’t have to consider it. What you don’t get to do is to say no for the people for whom it may be a consideration.

You have still failed to address any issue of substance on this post. Your attempts to divert attention and move goalposts constantly do not fool anyone. Your hypocrisy is exceeded only by your complete lack of integrity.

Amazed

Of course you did. I’ve noticed that likes are drawn to likes. Narcissists who whine about their discomfort against their babies’ lives and brain function potentially saved WOULD find you. And I bet the women who wanted to give birth at a time when they could get help had no idea that they were talking to a sanctimommy judging them. They likely believed they were talking to a professional and not a hardcore natural (when it was beneficial for her bank account) advocate.

swbarnes2

SIgh. As we’ve gone over and over…if pre-term increases were matched in decreases in neonatal deaths and stillbirths, that’s a good thing.

Mom, mom, mom. What’s a dramatically lowered risk of a dead or damaged baby compared to the horror of THIS? You feed the narcisism of mothers who think this way because it gets you nice sums.

Azuran

I think those women are just wilfully ignorant. Obviously, if you care so much about your birth experience, you clearly never actually faced the fear of losing your child. (or you are a psychopath)
I spent half the day at the hospital yesterday because my baby wasn’t moving. I called the hospital in tears after spending hours trying to get her to move. I don’t think I’ve ever been this scared or distressed in my entire life. Hearing her heartbeat once I got to the hospital was the most beautiful and reassuring sound ever. They kept me on constant monitoring for 1h30. Thankfully everything is fine (though just thinking about it is still making me cry).
But if at any time the doctor told me I needed an emergency c-section/induction or whatever, I would have done it.
I would have stayed hooked to that monitor all week if that’s what the Doctor recommended. Heck, if I could I’d rent it and wear it 24/7 until I give birth.
I’d drink nothing but juice and ate nothing until I gave birth if the doctor told me it was better for my baby.

And people are complaining that they can’t eat for their own safety? That the belt for the foetal monitoring is annoying? That they can’t walk around the hospital? Honestly, if that qualifies as a negative pregnancy/labour experience, then you had a pretty damn good time and you should be freaking grateful.

Empress of the Iguana People

Damn how I hated that blood pressure cuff. But it’s annoying, not horrendous. Truly terrible would have been my pre-e progressing and killing one or both of us.

momofone

I’m so glad everything was ok.

Sue

There are several very large, well-structured trials of home birth vs hospital birth, with good attempts to risk-match.

They consistently find that for first time mothers, neonatal mortality is at least three times higher at home than in hospital.

Examples include the UK Birthplace Study and the Australian Publicly-FUnded Homebirth study, published in the MJA.

These studies don’t even report – or even measure – the injuries or disabilities short of death. That would be very useful information, don’t you think?

The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).

nikkilee

This study is from Holland, where about 1/3 of the births are at home. With support services and a good transportation system, home birth is safe.

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United State

Looks like there is evidence for both sides of this debate.

Amazed

Thank you, nikkilee! I am so happy to see you showing a real study! Now, would you please highlight the Netherlands study (Holland isn’t a country, JFYI) comparing low-risk and high-risk births? Because high risk over there leads to better mortality rates. The difference between low and high risk? High risk is followed and delivered with obstetricians.

IOW, the study you trotted out only shows that Dutch midwives suck mightily. Do you include this bit when singing praises to the Dutch homebirth?

Azuran

And yet, I expect that transferring you took more than 5 minutes.
When you recommend homebirth. Do you specifically talk about a maximum safe distance? For example, I’m 20 minutes away from the hospital. Not counting however long it’s going to take me to get to the car and get processed once we arrive at the hospital. Is that too far? What if there is a snow storm? A car accident? A blocked road? And do you tell them to make sure their provider is actually working with the hospital and has a transfer agreement or hospital priviledge? Or is she just going to dump you in the emergency room?
And seriously, how freaking horrible must it be to have to transfer while in active labour?

As for your study. As Amazed explain. Dont you find it weird that home birth has the same death rate as hospital birth? That means that Doctors, who deal with ALL the high risk births, somehow manage to have the exact same birth rate as midwives who care only for the healthiest women with the lowest risks.
Now there are only two way this is possible. Either Doctors are so freaking good that they reduce the risk of all high risk birth down to the risk of low risk women (highly unlikely)
OR, Doctors actually have a LOWER death rate for low risk women then homebirth midwives. Which is then compensated by the higher rate of death of their high risk patient.

That, or course, is also without taking into account the fact that those midwives are actually nurse midwives. Not CPM, which, for some stupid reason, you are still suporting.

“Infants of low risk pregnant women who started labour in primary care had
a higher risk of delivery related perinatal death than did infants of
high risk pregnant women who started labour in secondary care”

Dutch midwives suck and I could never understand the praising of them as good providers. I guess it’s because we don’t want to sound radical, lest we push expectant mothers to think we’re extremists. But it’s very clear indeed: they suck. They might be better compared to the joke that is a CPM but they suck anyway. And we aren’t saying this as loud as it should, instead praising the Netherlands homebirth system as a safer one. To me, we should always add, “But less safe than hospital birth anyway.”

Roadstergal

Yes, yes, yes, and yes.

If you want your baby to live and you’re in the Netherlands, your best bet is to be just barely in the high-risk group and under OB care. You’re better off that way than with the most textbook low-risk pregnancy!

That’s some crazy Kafka-esque stuff, there.

Empress of the Iguana People

For my daughter, there is not specific benefit to her formula use, except that her mom’s PPD is exacerbated by breastfeeding. She’s better off on formula with a less suicidal mother.

momofone

I’d call that a very specific benefit.

Roadstergal

But nikkilee wouldn’t.

nikkilee

I thought that you all would like to see the latest for ACOG, experts on obstetrics, suggesting that interventions be limited in low-risk situations.

A friend of mine had her third baby at home recently. The Baby pretty much delivered herself. There was zero need for interventions.

In fact I imagine that’s why they’re called “interventions” because something has already happened to make intervening seem like a good idea.

Also any healthcare professional offering me a “massage” in labour would swiftly need to see a Doctor themselves.

nikkilee

Many women can’t bear to be touched in labor. Others enjoy it.

MaineJen

You seem to only believe in “personalized care” when the woman wants what you want. When the woman wants to follow her doctor’s recommendations and be augmented in labor (say, for prolonged ruptured membranes), or when the woman wants an epidural, or when the woman actually doesn’t mind not being able to eat because a) labor is excruciating and b) she feels like she’s going to puke, it’s all “she just doesn’t have the right information.”

How about you just butt out, and let the decision be made by the woman and her health care provider? (Does this rhetoric sound familiar? It should.)

momofone

I haven’t seen anyone advocating for interventions in low-risk situations. Unless you mean issues of maternal choice (c-section specifically) I doubt you’d find much disagreement.

I’d really like to see your answers to the questions you haven’t answered.

nikkilee

My protest is about interventions used routinely. As when a woman in labor is routinely given an IV with pitocin in it, and confined to bed, and denied food and drink, and told to hold still because moving influences the monitor tracing. I chose not to answer questions about individual situations because I can’t. I wasn’t there.

Daleth

Being denied food and drink is not an intervention. It is a precaution so that if she does need an emergency c-section, she won’t be at any risk of choking to death on the snack you loving NCB types gave her earlier. Food and surgery are not a good mix.

While many women have no urge to eat during labor, for those who need energy, try giving them spoonfuls of honey. I used to eat honey by the spoon before my law school exams because honey, unlike every other sugar I’ve ever heard of, contains both short- and long-chain sugars, so there is no “sugar crash” after eating it. In other words like all sugars it gives you immediate energy, but with honey the energy lasts longer and only fades gradually. And it’s impossible for a few spoonfuls of honey to cause perioperative choking like food can.

The Bofa on the Sofa

Being denied food and drink is not an intervention.

What does the ACOG say about denying food or drink?

Nikki brought up the ACOG recommendation to limit intervention, so I want to know, does the ACOG consider denying food or drink an “intervention” that should be limited? Or is Nikki just making that up?

What has relaxed is the old-school prohibition on drinking liquids during labor:

“The oral intake of modest amounts of clear liquids may be allowed for
patients with uncomplicated labor. The patient without complications
undergoing elective cesarean delivery may have modest amounts of clear
liquids up to 2 hours before induction of anesthesia. Examples of clear
liquids include, but are not limited to, water, fruit juices without
pulp, carbonated beverages, clear tea, black coffee, and sports drinks.
Particulate containing fluids should be avoided. Patients with risk
factors for aspiration (eg, morbid obesity, diabetes, and difficult
airway), or patients at increased risk for operative delivery may
require further restrictions of oral intake, determined on a
case-by-case basis.” (Same link).

nikkilee

Honey is fabulous, I agree.

Denying a health person food and drink is an intervention. The stomach is never empty; it’s always full of digestive juices. The prohibition about eating came from the 20th century days when anesthesia was more crude, and general or twilight sleep were the norms. ACOG has relaxed about women being able, if they want, to eat in labor.

Azuran

There is still a HUGE difference between a stomach with digestive juices and a stomach full of food.
Indeed, since general anaesthesia is rare in birth, most places allow women to drink a little and eat some light snacks.
So why are you complaining? Because the woman trying a VBAC, with risks of rupture and crash c-section isn’t allowed to eat?
Fasting is still recommended for general anaesthesia.

The stomach is not “always full” of digestive juices . The presence of food or liquids in the stomach stretches the stomach slightly which triggers nerves within the stomach to produce more gastric juices and acid.

The ACOG allows women with uncomplicated deliveries to drink clear liquids but abstain from non-clear liquids and food. Complicated deliveries should consult an ob – or more likely the anesthesiologist.

The prohibition about eating came from the 20th century days when
anesthesia was more crude, and general or twilight sleep were the norms.

What’s more important to you: that, say, 1 million women are more
comfortable in labor because they’re allowed to eat, but 10 women die
from aspirating that food? Or 1 million women are less comfortable, but
none of them die? Does your answer change if you personally know one of the 10 dead women? It shouldn’t.

Eating within 6 hours of going under general anesthetic is dangerous. The fact that it’s now the 21st century hasn’t changed that, and the rigid NPO (no food or drink) policy used in most western hospitals in the 20th century was too rigid, but it did reduce the number of women who died from inhaling semi-digested food into their lungs. That’s why this article suggests that the rule be applied less rigidly (let laboring women drink isotonic drinks to keep their energy up, but still prohibit solid food so they can’t choke to death):https://www.ncbi.nlm.nih.gov/pubmed/12698834

There was also a study of first-time moms in Australia–done in the 21st century, in case you care–that found that labor takes 3.5 hours longer when women ate during early and established labor, and 2.16 hours longer when they ate only during early labor. Do you tell your patients that?https://www.ncbi.nlm.nih.gov/pubmed/17011681

Roadstergal

That delay is longer than the ‘delay’ (confounders, obviously) introduced by an epidural, isn’t it?

nikkilee

And why is that a problem? Shorter labors aren’t necessarily better labors.

Azuran

Oh but when epidurals might make labour longer, then it’s unacceptable.

Roadstergal

Is that also your response when the NCB-ers bleat that epidurals are bad because they delay labor? Go ye and enlighten the midwives! Shorter isn’t necessarily better!

(I don’t care that eating might affect the duration of labor, as long as it’s not to a point that endangers the child. I care because of the risk of choking and death. The thing you’re steadfastly ignoring in your comments.)

momofone

It’s interesting that of all the comments you could have replied to (but have avoided), this is what you chose.

Roadstergal

100% ignoring the risk to the mother. Ignoring serious risks to mothers is kind of her thing.

Daleth

Take a poll among your patients. Ask them, “Who would rather spend 10 hours in labor than 20?” Or to be honest, “Who would rather spend 10 hours in excruciating pain than 20?”

Empress of the Iguana People

Nonsense, we don’t have pain during labor, we have *surges*. *eyeroll*

MaineJen

I will laugh in the $%^& face of anyone who says labor isn’t painful.

The Bofa on the Sofa

We should think about having a “commenter FAQ” for this blog, so that we didn’t have to repeat ourselves over and over again. For example, I would include my comment on pain in childbirth:

“Pain in childbirth was recognized 3000 years ago as being so severe that it was attributed to being punishment from God.”

I am a guy and have never experienced that pain, but I don’t need to to know that claims that it isn’t in general painful are bullshit. As are the claims that pain is a modern concept and that ancient natives did not have it.

Roadstergal

I have never gone through labor, despite having the parts. And I’ve had some really painful experiences – a compound fracture, various broken bones and lacerations, etc., so I thought I could at least guess. Then I had my cervix dilated just a little bit to put in my IUD, and OMFG. It’s not just the pain, which is pretty intense; it’s also how _deep_ the pain was. It engaged my lizard brain like I’ve never had it engaged before; it was serious fight-or-flight, and I had to grab the table to restrain myself from hitting the OBGYN and running out of the office. I can put pain aside if necessary; I dunno how you can put that kind of pain (what I had + a jillion) aside and think rationally.

myrewyn

Haha yep labor is indescribably painful and I have broken bones, torn my groin, and on a couple occasions been literally kicked airborne by a horse. Interestingly I didn’t find my IUD insertion to be painful but maybe that’s the benefit of having a cervix that’s already dilated in childbirth a couple of times?

Roadstergal

My OBGYN did say it’s generally easier when it’s not a dusty old unused cervix like mine. 😀

myrewyn

Oh and I don’t mean to diminish your pain from having an IUD inserted in any way. I just found it interesting how intensely painful you found it. I had no idea. Maybe that’s why the literature I got from my doc said it was mostly recommended for women who have had children.

Heidi

Probably. I know I used to have HORRIBLE menstrual cramps. Some months it’d be just really bad but every few months I’d have the kind that made me throw up and want to die. Labor felt just like that. Once I had the baby, though, I have no menstrual cramps at all. I’m guessing the big chunk of the pain was caused from my cervix dilating. I’ve also read that labor kills some of the uterine prostaglandin receptor sites.

myrewyn

That makes a lot of sense, actually. I had a similar experience with terrible adolescent cramps that went away after my first baby. I used to predictably miss one day of school per month for cramps that kept me in bed curled into a miserable ball and my mom had the same when she was young. A woman I know was ridiculing girls for missing sports practice over cramps and I wanted to punch her hard, probably in the cervix. Apparently she never had cramps like ours.

Roadstergal

Interesting – I had similar experiences to you and myrewyn, with horribly debilitating period pain that would immobilize me about one day a week. My poor dad (my mom died when I was 13) had to help me through it, and he mentioned that my mom had similar horrific period pain that went away after her first baby…

Mine went away when I went on BC. :p

Heidi

The fear of my period returning is one reason I tried so hard to make breastfeeding work and pumped around the clock. Then when it came back a little less than 3 months postpartum despite all my efforts, I was pleasantly surprised the cramps were non-existent.

Dr Kitty

Primary dysmenorrhoea is the fancy name for bad period pain that starts from the first period you ever have, tends to run in families (so mum, aunties, sisters, granny all had horrible periods) and it is historically known to be improved after pregnancy and birth.

The usual pattern is that pain starts with bleeding and is worse for the first day or two, easing up as the flow decreases.

There are lots of old studies that show that women with this kind of period pain not only have higher levels of circulating prostaglandins but also have more frequent and stronger uterine contractions during their periods.

This type of period pain also tends to come with fainting, vomiting and diarrhoea- which is super fun. Birth control to create anovulatory cycles or less frequent cycles also helps if a baby seems a bit drastic.

Endometriosis tends to cause painful periods that get worse as you get older, the pain starts days before the bleeding and lasts for the entire period, even if the blood loss is minimal. There is sometimes associated blood in the urine or stool and often painful intercourse. Anything that stops the bleeding (pregnancy, breastfeeding, menopause, ovarian suppression drugs) helps.

Some of us are super lucky to have both endometriosis and primary dysmenorrhoea!

Our local formulary suggests GPs prescribe Ibuprofen and Paracetamol for period pain. I laughed, bitterly.
In my experience if women have severe enough pain to bother seeing a doctor about their period, the over the counter stuff isn’t working, so I skip straight to the heavy stuff and the hormones.

Who?

Oh yes. Horrible periods here, from the very beginning. Mine was endometriosis, much better but not ‘normal’ on the pill.

Now on HRT, and having bad pain or heavy bleeding but not usually both, so back to the doc I go. Part of me wants to have my uterus out, which would leave me with one ovary and no bleeding, but not sure if that is even an option.

Dr Kitty

Interestingly, with Mirena #2 I had local anaesthetic in my cervix and so I experienced only mild cramping, but my cervix would not play ball and dilate.

Apparently my cervix has some stenosis and scarring from endometriosis and only dilates when I’m unconscious. Who knows what it would have done in labour.

MaineJen

I had mine put in 6 weeks postpartum, and all I felt was a slight pinch at one point. I think it makes a huge difference if your cervix has ever dilated before or not; I’ve heard another woman who’s never experienced labor describe IUD insertion as excruciating, too.

Although it wasn’t painful, I did get lightheaded for about 10 minutes afterward. Probably from my body going “What the #$% is that thing?”

Heidi

I had a similar experience when my cervix was chemically cauterized during my pregnancy. I could barely stand for a few hours.

Heidi_storage

Don’t forget the many instances when labor is used as a figure to describe the horror of an upcoming day of judgment, and the utter powerlessness of the people.

nikkilee

Labor takes about 24 hours. The study you quoted talked about making early labor a few hours longer. Early labor is manageable; it is the longest phase of labor, and the easiest. If a mother is encouraged and supported (eating, drinking, walking around) this is doable. She has to see the value in it before labor starts; this is where education comes in. This is a different attitude than others have on this forum. There is room for all of us. No, I didn’t like labor. And I was committed to letting it happen on its own timetable, because I knew the chances of complications were diminished. Worked well twice.

Roadstergal

Oh, hey, you’re here! I know you’re really good at avoiding questions, so there’s so many to direct you towards, so let’s start with that study you posted at the very tip-top of the page – easy to get to! – that said the opposite of what you said it said. Were you actively lying, or did you just not read it and got the link second-hand? Have you learned anything from the experience? Or is lying to clients just good business for you with no downsides?

rosewater1

And for you, that’s great. Good for you. But why are you so convinced that everyone can be like you? Or should be like you?

One of the head scratching things about the NCB movement for me is how they advocate for mothers to choose, to be listened to, to have their rights respected. BUT when that means “I want an epidural! I want a c-section!”-oh, THAT’S not acceptable. Pretty clear contradiction. And it’s insulting. Why can’t a woman choose to have pain relief? Why can’t she choose her delivery method? How she feeds her baby? What is gained by so many people being judge jury and executioner?

It’s really ironic that you would say “There’s room for all of us.” There doesn’t seem to be a whole lot of room for others in your views.

nikkilee

She can. . .and she does. My concern is that folks have enough education to make the best choice. After working in labor and delivery for years, I saw what happened and had the advantage of being able to choose to avoid that system. Most people don’t have that advantage. One mother I worked with who had 2 children with serious ear infections (with one that ended up with severe hearing loss) was furious that no one had suggested she breastfeed. She did breastfeed her 3rd baby; I worked with her during that time and she was still very angry that no one had given her the information that could just have possibly made a difference in her children’s lives.

maidmarian555

I call bullshit. Just go away with your judgemental nonsense. You’ve answered precisely zero question when it comes to individual cases and failed to provide exact answers when we’ve asked what you consider to be ‘legitimate’ interventions. Take your judgemental, lying, organismic birth-pretending shit elsewhere. I’m sick of your lies. You’re a liar that makes money out of fearful pregnant women and I’m tired of being polite about that. You lie and risk lives to make a profit. Whilst you may be totally fine with making a living that way, I’m not ok with the fact that people like you shame women on a daily basis just for a dollar. You’re disgusting.

Heidi

You are the worst. You are a horrible person.

nikkilee

Bless you.

Heidi

No, save it for the women who you’ve lied to, who you have convinced all their children’s problems and issues were from not breastfeeding so you could sell them the solution. It’s horrible enough to have a child with a health issue and even worse to have a child succumb to SIDS but you are there to rub salt in the wound.

momofone

So, nikkilee, planning to address any of the multitude of substantive questions you’ve evaded, or just sticking with the condescending responses?

Someone should tell that to my kids. They got it all wrong. My son “only” breastfed for 9 months, give or take, and he’s never had a single ear infection. My daughter breastfed until she was 2, and she had multiple ear infections.

It’s almost like…there are OTHER factors at play here, besides breastfeeding.

Amazed

Routine interventions reduces the risk of mother/ child dying and/or being permanently damaged. Somehow, I don’t see that as mattering to you. You sell your crap because you have to make a living and if it goes over the dead bodies of moms and babies – well, that’s bad. At least mom got to eat at home to her heart’s content. Right before the tragedy hit. But at least she was better equipped now to handle it because she was fed, aka strong. Far better than being hungry and exhausted in them evil hospitals holding a healthy baby.

You’re all for reducing risks but only certain risks. The ones whose reduction leads to filling your purse.

Please.

Azuran

Oh geez. Ear infection. The deadliest of all childhood illnesses.
Seriously, considering the rate of ear infection and the complication rate of ear infection. Please, do calculate how many babies need to be breastfeed in order to prevent any kind of permanent injury.

And please. How does that risk of ear infection compares to all the babies who end up dehydrated, jaundiced or brain damages because of inadequate milk supplies in the first few day?

Empress of the Iguana People

Knock on wood, there’s only been 1 ear infection in my house in 4 years, and that one in an adult.

The Bofa on the Sofa

My older son was EBF for about 3 months and then combo fed until 9 months where he gave up nursing altogether. And he never had an ear infection that whole time – heck, he only had one cold the whole time.

Then at about 14 months, he went on a streak of getting sick like every other week. What was the difference?

He went to daycare.

Roadstergal

Oh, hey, you’re here! I know you’re really good at avoiding questions, so there’s so many to direct you towards, so let’s start with that study you posted at the very tip-top of the page – easy to get to! – that said the opposite of what you said it said. Were you actively lying, or did you just not read it and got the link second-hand? Have you learned anything from the experience? Or is lying to clients just good business for you with no downsides?

rosewater1

Um, what? No one suggested breast feeding to her? Not just once but twice?

And I’m not getting the hearing loss thing as it relates to breastfeeding. Really? If you don’t breastfeed your children they are doomed? Really?

If you REALLY want to do something about what you see as “injustices”-get off this page and do something constructive to change matters. Clearly what you are selling no one is buying here.

Empress of the Iguana People

Apparently, chewing’s motion helps prevent ear infections, or so my health teacher said many moons ago (refering to chewing gum). Not that sucking is the same as chewing.
But what are the chances that no one mentioned breast feeding? Damned small, I’d say. Not to mention that bf’ing is no guarantee of anything! Neither of my kids have yet had an ear infection. (One’s bf’d, the other’s ff’d) I was bf’d and I did get the occasional infection.

Roadstergal

If it’s the sucking motion, wouldn’t bottles and pacifiers have the same effect?

Azuran

And my brother was breastfed, he had ear infection all the freaking time. We spent Christmas in the emergency room every single year because of him.
I wasn’t breastfed, had 0 ear infection as a baby.

Breastfeeding wouldn’t have stopped her 2 other kids from having ear infection, or at best, they would have had 1-2 too less. You are far over blowing the benefits of breastfeeding and making this poor woman feel guilt for something that isn’t true.

Linden

If someone told her the ear infections could be completely avoided with bf, they lied to her. If she had another kid after the third, she’ll probably be mad about that bs.

Who?

I breastfed my son and he had loads of ear infections.

Do tell me how I must have done it wrong, somehow.

Daleth

The study you quoted talked about making early labor a few hours longer. Early labor is manageable; it is the longest phase of labor, and the easiest. If a mother is encouraged and supported (eating, drinking,
walking around) this is doable.

That’s not your call to make. It’s hers–the woman in labor. If you’re talking to women about eating during labor, you should tell them it could add 2-3 hours to the length of labor and let them decide. Why not tell them that, offer isotonic drinks or spoonfuls of honey as an option for keeping their energy up without the risk of lengthening labor or hugely unpleasant vomiting at transition, and LET THEM CHOOSE?

If you genuinely respected women, that’s what you would do.

Roadstergal

While I agree, I think her telling women it could add 2-3 hours to their labor is not the totality of her responsibility. She needs to tell them they risk _choking and dying_ if an emergency surgery is required, and note that fluids in the ACOG guidance do not. That’s what respecting women looks like.

Daleth

Yes, absolutely. Here are the risks; here are the benefits; here’s what ACOG recommends; now you choose, since it’s YOUR life, YOUR body, YOUR baby.

Daleth

No, I didn’t like labor. And I was committed to letting it happen on its
own timetable, because I knew the chances of complications were
diminished.

Prolonged second stages and prolonged pushing phases are associated with increased adverse neonatal outcomes. This study included 42,539 first-time moms with singleton, full-term, head-down babies–in other words it was a large study of low-risk babies, which adds strength to their conclusion.https://www.ncbi.nlm.nih.gov/pubmed/27929527

A prolonged pushing phase is associated with an increased risk of c-section for the mom and adverse outcomes for the baby. This study included 53,285 women, both nulliparous and parous, all with singleton, full-term, head-down babies and no prior c-sections. So again, strong support for the findings.https://www.ncbi.nlm.nih.gov/pubmed/26959213

And you’re not even right to claim labor normally takes 24 hours. In this study, done in Scandinavia where the rate of interventions is much lower, the “total median duration from onset of labor until the birth of the baby was approximately 14 hours for primiparas and 7.25 hours for multiparas”–and again, a longer pushing phase was bad news for the mom: “blood loss more than 1,000 mL and perineal ruptures that needed suturing were associated with a longer pushing phase.”https://www.ncbi.nlm.nih.gov/pubmed/26467758

Dr Kitty

Labour takes about 24 hrs?
It really shouldn’t… and if it does, someone should be intervening, and intervention leads to reduced CS rate and improved outcomes.

From this very old but still relevant WHO publication about the Partograph:

Before partograph introduction in Zimbabwe:
13% of labours lasted over 24 hrs.
Perinatal mortality was 5.8%
CSection was 9.9%

After partograph introduction in Zimbabe:
0.6% of labours lasted more than 24hrs
Perinatal mortality was 0.6%
Csection rate was 2.6%

For Malawi the figures showed less marked improvements, but still improvements:

Oh, and my mother was one of the many medical students in Zimbabwe back in the day who put the partograph data into what passed for a computer, and she said that it literally changed things overnight in the big teaching hospital in Harare.

But sure nikkilee, you keep believing most labours last 24hrs and are safer left to proceed unhindered by modern evidence based practice.

The Bofa on the Sofa

I think the word nikkilee is looking for is “schooled”

The Bofa on the Sofa

I have to say, this is about the funniest thing I have ever heard.

Let’s see….long painful labors are ok if you get some food. However, give you pain relief, and now long labors are horrible things to be avoided.

Why do you hate women so much?

momofone

Exactly.

Withholding food, resulting in the discomfort of hunger = abominable and irresponsible

Well, it’s not okay to withhold from laboring women for safety reasons (and I doubt that many are hankering to eat actual solid foods anyway) but it is a-okay to withhold food from your newborn infant if your supply hasn’t come in (or like me, possibly never comes in).

rosewater1

But, but, infant stomach size is tiny! But but magical breastmilk!

nikkilee

Have you ever worked with a woman who is both angry and depressed because her labor went so fast she didn’t have time to get an epidural? Have you ever worked with a mother or a baby who are in shock because labor went so fast?

Heidi

Have you been one of those women who experienced a very quick labor? Nope (I’ve read your little birth biography)! Food isn’t going to slow down those of us who labor quickly. I bet most of us, and I speak from personal experience, have no desire to eat in the middle of a painful, quick labor.

nikkilee

Agreed. Women should be able to drink and eat if they want. . . not routinely denied food and drink because they are in labor.

Azuran

I don’t think Heidi’s point was that women should eat in labour.
Why are NCB advocate freaking so much about this eating stuff anyway? Most women don’t even want to eat. I sure as hell have never heard even 1 mother complain or even mention that she was hungry while she was giving birth. And even then, many places actually allows you to eat lightly until we start active labour.
People have to fast for tests, medical procedures or surgery all the freaking time and they don’t whine about it. Sure, it sucks, but no one is freaking dying from it. Jesus, you can handle pushing out a baby without an epidural but you can’t handle not eating?

momofone

Well, sure. Going without an epidural makes her a warrior. Not eating during labor? That’s just oppression, man.

nikkilee

If you want to eat, you should be able to eat. I’ve seen a few women in labor who were hungry; more are thirsty. People riding in bike races or running marathons can drink and eat; some view labor as a similar endurance event and want the choice.

Who?

Of course you can eat-the question is whether doing so is a wise choice in all the circumstances. Is a snack worth dying for?

nikkilee

No risk of death if a woman eats in labor. Some women have huge meals, then go into labor.

“Eating and drinking in labor is a controversial subject with practice varying widely by practitioners, within facilities, and around the world. The risk of aspiration pneumonitis and anesthesia-related deaths at cesarean section has resulted in adherence to historical practices of starving women in labor. Studies have shown that the risk of this anesthetic-related complication is low. It is the fear of the birth-attendant to bear full responsibility if a patient inhales gastric contents when giving in to demands for liberal fluid and food regimes during labor that governs practice. While the bulk of evidence supports fluid intake in labor, there are insufficient published studies to draw conclusions about the relationship between fasting times and the risk of pulmonary aspiration during labor.”

Once again, did you even read that? It says: Whether or not allowing food and fluid throughout labor is beneficial or harmful can only be determined by further research.
Meaning: We don’t know, so we are taking the safe approach.
And the problem isn’t aspiration during labour. It’s aspiration during anaesthesia.
And as much as you are pretending that there is a huge Doctor conspiracy to make women suffer. I do have the right to eat lightly up until I’m in active labour and I have the right to drink basically anything during the entire labour.

And the ‘if you want to eat, you should be able to eat’ it’s just stupid. That’s not how it works you dumbass. I wanted to eat the two times I had to do the GD test, or the two times I had surgery and the time I had an abdominal US. So according to you, screw the test, just eat? When my mom had brain surgery, should she just have eaten because she was hungry? Should my dad have eaten food on the morning he got his stents for his infarcts?

People in marathons and labour are too different things. Comparing the two is just stupid. Those who think they are the same are just as stupid.

Daleth

The risk of dying during a minor outpatient surgical procedure is low too, but it killed Joan Rivers among many other people, and because the risk exists, doctors have to warn us about it so we can make up our own minds.

Why are you so gung-ho about eating during labor? Why aren’t you interested in just letting women know what the risks are so that they can decide for themselves?

Perhaps it’s because most women, if informed that eating solid food during labor has a small but real chance of KILLING THEM, would decide to keep their energy up with juice, honey and protein shakes instead of food. In other words, most women wouldn’t make the decision you think they should make.

Would you mind BACKING OFF and respecting women’s ability to make informed decisions, even when they’re not the decisions you personally prefer?

Empress of the Iguana People

She sounds like she thinks every woman actually wants to eat during labor. I did for the first few hours with #2 because I went in just before i was supposed to make dinner and had only a cucumber sandwich for lunch, but i wasn’t *starving*, just peckish. Then the pitocin really kicked in and I stopped caring. (I was induced for bp)

Daleth

She does sound like she thinks that. Which is an absurd thing to think–perhaps try LISTENING TO EACH INDIVIDUAL WOMAN instead of reaching sweeping conclusions as to what all of them supposedly want?!

momofone

I’m consistently astounded by the lack of wisdom in nikkilee’s choices/sales pitches.

Azuran

Oh it’s actually quite simple.
-Any risk or consequences of something done by a doctor/medicine is horrible.
-Anything positive done by a doctor/medicine is irrelevant.
-Anything positive done my breastfeeding or midwives is absolute gold and should be the standard for anyone
-Any risk or consequences of breastfeeding or midwives is irrelevant.
And yes, this remains true even when the risk is the same in both situation. It’s good when it’s done by a midwife, but evil if it’s done by a doctor.

Which is why, being hungry in labour is evil. But a newborn starving for days is ok.
Or a longer labour because of an epidural is evil, but a longer labour caused by eating is good.

momofone

You know, as a grown person, you can take any food and drink with you that you want. You can eat it when you want it. You can drink what you want, when you want. No one’s going to physically remove it from your hungry little hands. Now whether that’s smart or not is another thing altogether, but you can rail against The Man all you want. You’ll show them!

Roadstergal

You have yet to acknowledge the true reason for the recommendation, which has nothing to do with labor duration and everything to do with THE RISK OF THE WOMAN DYING.

Again, is this what you do with your clients? Conceal the risk of death? Sweep it under the rug and if it happens, note that not all mamas were meant to live – or better yet, that it was somehow due to those awful interventions?

swbarnes2

You really aren’t going to address the fact that you are a plagiarizer and liar? Do you even understand what is wrong behaving like that? I wonder if deep down, you really don’t understand what you did wrong.

The Bofa on the Sofa

Wait a minute.

Are you suggesting that a woman who is experiencing a precipitous labor should try eating something to slow it down?

Roadstergal

That’s today’s twist and turn to get her out of the corner she painted herself into. She still has yet to acknowledge, BTW, the true risk of eating in labor – the risk of choking or dying. Like any good NCBer, she’s beating the ‘slowing down labor isn’t a bad thing!’ drum to distract from the real risk.

Daleth

PS: your statement that “ACOG has relaxed about women being able, if they want, to eat in labor” is wrong.

What they’ve relaxed about is this: low-risk women with uncomplicated (so far) labors can drink “modest amounts of clear liquids,” but “solid foods should be avoided.”

SOrt of OT but I remember my Lamaze class nurse saying that once labor started it was a good idea to stick to ice chips and water. She said that many of her patients in labor vomited when they hit transition (and that it didn’t matter if they were going all natural or got an edidural. Well dopey me figured I’d be in labor for hours and had a 7-Up and a baked potato. Which I got to see again when I hit transition…blergh

Heidi

I threw up during labor, too, before and after the epidural. I hadn’t eaten in hours and I had already been throwing up breakfast for a few days.

Daleth

Oh argh. How unpleasant, you poor thing!

MaineJen

Have you been listening to anything we’ve been saying the past few weeks? There are good reasons for these things being done. We’ve given you specific examples. We can’t keep making the same arguments over and over.

Heidi

Have you been listening to anything we’ve been saying the past few weeks?

No, she hasn’t.

Azuran

Didn’t stop you from telling that random woman you didn’t know that she should tell her pregnant daughter to not listen to her OB.

momofone

Yet you also say that doesn’t necessarily happen routinely. Which is it?

Regarding your not being there, you seem quite comfortable sharing your opinions broadly, but don’t have much to say when people offer experiences that contradict your opinions. Your lack of response comes off (to me) as avoiding the question.

rosewater1

I’m still not clear why these things are bad. Hospitals aren’t dungeons. Women aren’t tied down against their will. In the interest of full disclosure: I work in a hospital, in OB. I’m not a doctor or nurse. I’ve never seen interventions for just their sake. And I’ve been full time for TEN YEARS.

Consent is major. EVERYTHING is explained and consented prior to it happening. The consent for an epidural is 1 page-front and back with ALL the complications.

When you go to a hospital, you go with the understanding that the professionals know some things more than you do.

If you don’t understand something…ASK THEM.

I’ve also seen nurses advocate-firecely-for their patients.

I’m really not sure what you gain by this broad brush painting. Aside from perhaps pushing your own agenda?

Azuran

And I see nothing in this that is proving your point. Everything in this documents are things that are already being done.
Hey, guess what, If I’m low risk, I even have the right to drink lightly and eat a few soft things during labour. I also have the option of a pool, I have the right to a support person with me all the time. No one’s membranes are ruptured for no reason. No one is put on pitocin routinely ‘just because’. No one is induced ‘just because’. No one has c-section because the doctor had enough.
You have no proof of anything that you are trying to say. All you do is take the random comments of other biased people to confirm your own biases.

Visitor

Irony alert.

sdsures

I can’t believe you actually wrote that.

nikkilee

A participant in class asked about the “Breast is best” slogan, wondering if it should be used. I said no, because it doesn’t help anybody.

momofone

And did you go on to say that the most important thing is that babies are fed?

swbarnes2

Right, like how you have control over what you post, and you decided to plagiarize and lie. Fundamental dishonesty leads you to choices like that.

Heidi

I have no hopes of changing her mind! My thoughts if someone is thinking of using her services (or fencesitters or moms who might be feeling guilt about having to formula feed), they’ll read our stuff and notice her little game of cricket when she knows she’s wrong.

maidmarian555

Yeah this. I remember when I found this site. It was the first time I’d really seen the NCB movement properly challenged online. I have so many friends who’ve been hurt by it (whether it’s via chronic unnecessary guilt for c-sections and formula feeding or indeed those who’ve had unmedicalised natural births who were shocked and traumatised by the pain and brutality of it). It’s pretty rare to find somewhere where their rhetoric and ‘facts’ are properly challenged, debunked and criticised. I thought I was going to be a sensible, rational mother and have never really been even vaguely crunchy. I still (mostly) am but in my post-partum fug I was really damaged emotionally after accidentally stumbling on NCB sites. It felt like such a weight was lifted when I came here and read the BTL commentary and saw people like Nikki Lee and her ideology torn to shreds. It made me realise that actually, the way I felt wasn’t ‘wrong’. I wasn’t a ‘failure’. Their movement is and their bullshit and cruelty should be called out for what it is.

The Bofa on the Sofa

Well, it’s kind of the on-line version of running her panties up the flag pole for everyone to laugh at. But instead of stealing them, she hands them to us.

Sarah

It’s always worth correcting her because you never know who’s reading. If it stops one person from being influenced by her pernicious shit, it’s worth it.

sdsures

Resistance is futile; we are the Borg.

Christy

So sorry this is off topic, but I have to vent. In a parenting group that has nothing to do with health, a mom mentions a woman in her community who lost a baby to SIDS. By the 3rd response the anti-vax vultures were already speculating that the baby died of vaccines. Because package inserts. I don’t do Facebook drama but I am so angry right now!

Sue

Not to mention the fact that vaccinated babies have LOWER rates of SIDS/SUDI:

AND that SIDS/SUDI rates have fallen dramatically during a time that the vaccination schedule has expanded.

nikkilee

Oh are you quick and smart, Dr. Amy. The facts are still true. There is no labor drug FDA-approved for infant safety. Human milk, a cousin to human blood, will always be best for human infants. Maternal mortality in the US is rising to the highest of any developed nation; as far as infant mortality goes, currently the US is ranked 28th, in a country where over 1/3 of women have their babies surgically delivered, whereas the WHO suggests that surgical birth rates are best at 10-15%; less than that, and not enough are being done; more than that is too many. However your points about the privilege factor in childbirth and breastfeeding are interesting and reflect your desire to keep learning. I appreciate that. A goal of teaching is to inform, never to make anyone feel bad; this is an ideal, and, unfortunately, not always real. But still a goal. The most important thing about infant feeding is that the mother loves her baby.

StephanieJR

The most important thing about infant feeding is that the infant is FED. If you love your child, you feed them what is best for them, and formula is a perfectly good substitute for breastmilk. Breast is not always best. Fed is.

Azuran

Actually, human milk is a cousin of human sweat, not blood.
It is no more magical than any other liquid your body produces.

And funny, how to you explain that despite our relatively similar use of medical intervention, Canada has better outcomes? Perhaps free health care helps a lot.

nikkilee

You bet, about the free health care. As for blood versus sweat, seems that sweat glands and mammary glands diverged about 100 million years ago. Human milk contains much that sweat doesn’t: stem cells, lots of different white blood cells, bioavailable iron bound to a protein.

Azuran

Try injecting Breastmilk Intra-veinously, then tell me how you feel.
There is no such thing as breastmilk being like a cousin of blood. It doesn’t even mean anything. It’s just gibberish peddled by idiots who want to believe that they have magical powers.

sdsures

It’s a bodily fluid, like urine – that is its only similarity to blood.

Gæst

I don’t understand how bodily fluids can have cousins at all. Do they also have mothers and fathers? What or who is the mother of my blood? If I have a blood transfusion, is that like having a blood step-sister? Or maybe this whole metaphor is just asinine.

Sarah

Your doula.

Azuran

Also, so you agree that better health care leads to better outcome, not lower c-section rates.

Heidi

Guess what contains “antiseptic enzymes (such as lysozymes), immunoglobulins, inorganic salts, proteins such as lactoferrin, and glycoproteins known as mucins that are produced by goblet cells in the mucous membranes and submucosal glands”? Snot! Let’s feed babies snot then! Sounds pretty magical and awesome, too!

Now, I’m all for breastfeeding if mom wants to breastfeed, there’s enough to sustain baby, and it isn’t contributing to any mental or physical anguish, but it ain’t magical.

Certainly children eat enough snot; nice to learn that it is good for them. As for breastfeeding, it isn’t magical. It is amazing, as amazing as any other body process such as brain function or immune function. But it isn’t magic fairy dust. It does give babies a better chance for a healthy life, just as seat belts don’t guarantee survival in a car crash.

Heidi

“It does give babies a better chance for a healthy life”

Nope! Getting enough of an appropriate substance does and formula fits that bill. Babies died all the time when breast was almost the only option. Where the breastfeeding rates are the highest so are the infant mortality rates. Thanks to quality tap water and high quality formula, my son does have a healthy life that does not involve dying of dehydration nor starvation. It also did not involve accidental suffocation. Nikkilee, I remember being so sleep deprived when my son was first born that I would nod off sitting straight up. Fortunately when I just couldn’t do it, I handed the baby and a bottle off to someone more rested than me.

nikkilee

There are so many factors to infant survival; breastfeeding is only one of them. Talking about babies in general is not talking about you and your baby specifically.

The Bofa on the Sofa

There are so many factors to infant survival; breastfeeding is only one of them.

And a trivial one at that. You aren’t the first lactivist to admit that when it comes to healthy babies, there are a lot of things that are far more important than breastfeeding.

Azuran

Yesterday my SIL described her night feedings of her baby as: Getting up, sitting on the chair, putting him on the breast, falling asleep, waking up when he’s done, putting him on the other breast, falling asleep, waking up when he’s done, putting him back to bed then going back to sleep.
Somehow that doesn’t sound very safe.

Elizabeth A

Infant mortality (deaths up to age 1) is a measure of pediatric care and social services, not of obstetrical outcomes. The WHO admitted that it basically pulled that 10-15% number out of thin air – it is not applicable to all populations. The important statistic about c-sections is that every mother who needs one gets one.

The most important thing about infant feeding is that the infant is fed. Who feeds the infant, and that person’s feelings about the infant, are far lesser concerns.

MI Dawn

nikkilee: the WHO does NOT suggest surgical rates of 10-15%. That’s a very old number and one not supported by actual research. Try updating your tropes.

The most important thing about infant feeding is that a mother FEEDS her baby. It does not matter how she does it (breast or bottle, breastmilk or formula) provided the food is supplied and appropriate for the child’s age and health needs.

Uh, yeah, that might work for countries where women don’t have access to birth control and the surgical technology is so poor that c-section complications can turn fatal. In other words, not here.

Nick Sanders

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” says Dr Marleen Temmerman, Director of WHO’s Department of Reproductive Health and Research. “They also illustrate how important it is to ensure a caesarean section is provided to the women in need – and to not just focus on achieving any specific rate.”

So, no, WHO does not “stand behind” 10%.

Box of Salt

In the WHO’s FAQ: “In addition, in some societies, delivery by caesarean section is
perceived to preserve better the pelvic floor resulting in less urinary incontinence in the future or sooner and more satisfactory return to
sexual life.”

Put a fork in my own eyeball moment: since when is desiring less future urinary incontinence a bad thing?

Sue

What most people seem to miss is that the WHO was trying to define a MINIMUM standard of access to Cesarean section, not a maximum.

WHO is concerned with WORLD health – in a world where mothers and babies die for lack of access to effective care and necessary
interventions.

Sarah

You haven’t even bothered to read what you’ve posted! The sidebar of the link contains a link to FAQ. The VERY FIRST one of the questions is whether the WHO have a recommended section rate at country level. The VERY FIRST word of the answer is ‘No’.

Maternal-fetal medicine is a complicated field because risks and benefits need to be continuously measured and evaluated. Infants only exist after a pregnancy has ended (ie after birth). And there are plenty of circumstances during pregnancy that pose significant risks to fetal health, well-being and survival. So we make use of medications utilizing a risk-benefit approach. What, exactly, is your point and/or position? That no drug is to be used on a pregnant woman ever?

Empress of the Iguana People

probably

nikkilee

No point. Merely a statement of fact. What happens is, as you say, a matter of benefit/risk analysis. That women get what they need in labor, and are treated as individuals, and that each labor is treated for the unique event that it is, and that interventions are used as needed, instead of as routine.

Who?

You jump from ‘safe for baby’ to ‘mother’s needs’ pretty fast there.

Who decides what mother needs?

Surely diversity of treatment is more likely to be a sign of individual care than not. Yet in birth centres, diversity of care can’t be provided-it’s either what they can do, or off to hospital.

Surely the hospital is the best place to ensure women get what they need, as opposed to what a birth hobbyist thinks they should want.

Sarah

Lactivists decide what mother needs. Come on, you know this!

sdsures

“There is no labor drug FDA-approved for infant safety.”

Nikkilee, when you show me proof of your medical degree with a subspecialty in MFM, I’ll listen to you. Otherwise, there’s no proof to your claims, and you don’t have the education to back them up.

nikkilee

Name one drug that is FDA approved. I’ve worked in maternity for over 40 years, including 4 different hospitals. Here’s an area of cognitive dissonance, where women are cautioned against taking an aspirin or a beer in pregnancy, yet are given narcotics in labor.

sdsures

Answer my question.

sdsures

Narcotics during labour are given under CONTROLLED CONDITIONS IN A MEDICAL SETTING. Stop being stupid. Beer and aspirin during pregnancy are not, unless you are prescribed aspirin by your GP and your OB signs off on it, and you do not spend the entire pregnancy on bedrest in hospital.

nikkilee

That doesn’t mean they are good for babies.

Heidi

There you go with your shamey shame shamin’ again. “Oh, you should be able to make your own decision, but just be aware, it’s probably HORRIBLE for your baby! But it’s all your choice, you know, you’ll probably just kill your baby, but I totes support you.” So the argument goes that there’s no safe drug to take during pregnancy. This coming from a person who published a book embracing homeopathy and adjusting babies who won’t breastfeed.

sdsures

They’re for the mother’s pain.

sdsures

They’re good for the mother’s pain.

Amy Tuteur, MD

You seem to have utterly missed the point, nikkilee.

fiftyfifty1

“Human milk, a cousin to human blood”

No, not really. Milk is actually a cousin of sweat. Apocrine (armpit and groin) sweat, not eccrine sweat, to be exact.

Sue

Yep. And urine is (filtered) blood, without the red cells, proteins or pus.

Empress of the Iguana People

…hopefully…

CSN0116

nikkilee! Hi! Can I have your ear for a moment?

Can you please explain to me why, I’ll call them breast feeding advocates, continuously harp on the fact that breast milk is unlike any other substance and that formula will never compare? I understand that those things are true, of course. But where I come from, something that is superior has to produce superior OUTCOMES in order to be worth its claim. So, the fact that breast milk has stem cells, and loads of white blood cells, or even magical unicorns in it is kind of all lost in glory when we get to outcomes assessment, no?

Aside of the whole “you can’t pick out a non breast fed person from a breast fed one,” there are the facts that no health questionnaire anywhere asks how long I was breast fed for. It will ask me a whole ton of other personal and family-related health questions, but why not something so vital? My lack of being breast fed should put be at increased risk for several diseases and even cancer. Wouldn’t my doctor need to know this to tailor my care?!

Why do my children’s school registration forms ask in what gestational week they were born and their birth weights (both highly correlated to academic achievement), but not how long they were breast fed? Surely they would want to know if they were totally deprived of this substance, so that they can be promptly placed in remediated tutoring or something, bringing them up to par with their breast fed classmates, reducing disparity, and ultimately saving the school district money?

Surely these things are not practiced because all of us here know (including you) that whatever breast feeding benefits exist are beyond trivial and in no way clinically significant, which is why no health care provider cares to know about how we were fed as infants. I don’t think you can argue your way out of the damning evidence that the obesity, asthma, cancer, allergies, colds, GI illness, bonding “benefits” …have all gone to shit. They’re not real.

So explain to me why you continue to point out how “speshul” this substance, that is incapable of producing any discernable positive OUTCOMES, is? Why not play it up in some other fashion? Using fancy terms for what breast milk contains is just so futile in my opinion, because nobody’s buying it. Shit, kale and spinach are inherently different too, and will never be equal… but I think you get the point.

Please elaborate.

Who?

It’s a feelings thing.

That’s all.

CSN0116

Sigh. It’s just so stupid. Like claiming and bragging that my kid comes from a royal blood line, has perfect body proportions, and is ambidextrous with a photographic memory… BUT she is dead middle in class rankings, average looking, and mediocre at sports. WHY would I continue to play up these attributes? I’d look like an irrelevant moron.

Who?

It just flashes me right back to early teens/high school. All those mean, bitchy competitive girls competing over trivial crap and being horrible to anyone who didn’t fit their template.

In retrospect, and having watched teen girls in action from a parent’s perspective, it’s just insecurity and anxiety. Really annoying to be on the receiving end though.

Azuran

And especially: Life and medical Insurance companies.
They didn’t ask me how long I was breastfed. Yet if ANYONE is going to care about every little thing that might make you less healthy, it’s freaking insurance companies.
How could they not care how much magical breastmilk I got?

CSN0116

This is an amazing point!

nikkilee

That’s been a mystery to me also. I’ve been working on that for years. Insurance CEOs would make way more money if more babies were breastfed, as healthcare costs for mothers and babies would be lower in both acute and chronic situations.
Could it be that in a corporate nation, industry dominates, and that the billions of dollars made by the formula industry speak loudest? In Japan, how long a baby breastfed was part of a school entrance history; I don’t know if that is still true.

CSN0116

Could it be that statisticians working for insurance companies are quite fabulous at what they do and bias-free when it comes to infant feeding? They just analyze what they need to analyze and interpret it. Could it be that they have all figured out that the statistics do NOT support lower health care costs related to breast feeding? Do you really think that the profit-seeking scumbags at the leading insurance companies would let the infant formula market step in front of “billions of dollars” in their pockets and the pockets of their shareholders?! LOL You’re incredibly disillusioned regarding the “power” of Enfamil and Similac.

For Christ’s sake, some 1 in 20 EBF newborns are readmitted to special care for starvation-related issues like hyperbilirubinemia and dehydration. One day in special care utterly dwarfs the costs of an extra two colds and one gastro illness (neither of which require medication or even an office visit, and so long as a fever isn’t present, that kid can still go to daycare and my ass to work) that my formula fed baby “supposedly” contracts in its first year. And you know that adult chronic illness related to not breast feeding are all riddled with socio-economic confounders.

sdsures

My premature birth t 28 weeks, and the cerebral palsy and hydrocephalus caused by it – leading to severe chronic migraines in adulthood – all occurred before I was fed a single drop of breastmilk or formula. I was fed breastmilk because my mom was a lucky woman who had enough to not just feed me, but the ENTIRE NICU.

So, the argument that FF babies have more chronic illnesses is, at least in my example, shown to have no correlation.

Mariana

My husband, who was fed whatever milk was available (he was even breastfed by a family friend) because my mother-in-law had no milk, had his first round of antibiotics at age 30! And an allergic reaction to them 2 days after that. But come on! You can’t say he wasn’t a healthy kid!

sdsures

Needing antibiotics is only one measure of when a person gets sick. For instance, nobody gets antibiotics for the flu or a cold.

nikkilee

In one study, the incidence of hypernatremic dehydration overall was 0.04% for hospitalizations of babies over 2 weeks old. In another, it was 1.9% Where does this 5% figure come from? Hypernatremic dehydration also occurs in formula-fed babies, when caregivers use it incorrectly. Sometimes they mix it incorrectly out of ignorance, or error, or hoping to resolve constipation. True it does occur more often in the exclusively breastfed baby; to blame breastfeeding per se for that is an incomplete view, and points out the complexity of our deficient health care system, community skills and social support.

CSN0116

Well, let’s talk about that. Our health care system and much of the community and social support networks promoting breast feeding, like WIC and Le Leche League, all seem pretty preoccupied with the recommendations set forth in BFHI. And regarding the health care system, in particular, BFHI is completely institutionalized and runs the show.

The unfortunate bit with all of this, is that the BFHI tenants are horribly dangerous. Their “rules” on formula feeding, exclusive or supplemental (#6.1 in the US version), are demeaning and patronizing, and set babies up to be starved and readmitted. And the 2-4% EBF readmission rate was referring to USPSTF’s updated recommendations.

But let’s sort this all out. If I BF, my breast pump will be paid for (~$200). My employer will have to give me time to pump and I will either cost my company money, or my family my time with them. My baby will need additional weigh-ins in the early days. I will most likely need lactation consultations. I will need to give certain vitamin supplements to account for what breast milk is deficient in. My baby is at higher risk for readmission, hyperbilirubinemia , dehydration, and long-term neurological damage that can be caused by these things, the effects of which can be seen and quantified all the way through elementary school on standardized testing. My baby is at *higher* risk for allergies. And I risk diagnoses of my own, like mastitis and thrush, that will require office visits and meds.

HOW…HOW can all of this be cost saving? You’d be lucky to break even on the “increased acute and chronic illness” front, but it seems perfectly plausible that because it is natural and nature is so prone to failure that needs fixing, breast feeding COSTS the health care system, individual families, and the school system loads of money.

What are the complex deficiencies in the health care system, community and social supports, in your opinion?

nikkilee

1) Lack of support for mothers. 23% of mothers are returning to work at 2 weeks or less. I got the figure from an administrator of AWHONN, and have validated it. No paid maternity leave as a national policy; if one is lucky enough to work for certain companies (Johnson and Johnson come to mind first), then paid maternity leave is available, but for the majority of mothers, there is none. In the US today, Most healthcare professionals are poorly educated, if educated at all, about breastfeeding. At one medical school where I teach, students get 2 hours of education about breastfeeding in 4 years. This is more than many schools offer, and far from what is necessary.

2) An overworked and underfunded hospital system, where nurses and lactation professionals are caring for more than they should be. When a nurse has to care for more than 3 couplets, i.e. 6 people in one shift, care suffers. (3 couplets is the AWHONN recommendation, and this was quoted in the recent AAP updated SIDS and Safe Sleep Policy). When a lactation professional is expected to see 20 or 30 or more breastfeeding mothers in one shift, care will not be good. It can’t be; not a fault of the nurse or lactation professional, this is a systems issue. The rules and regulations and requirements placed on maternity staff plus the fact that charting on the computer (originally promoted as saving time) actually does the opposite; staff can spend twice as long charting (many hospitals have one charting system for mothers and another for babies, and the systems don’t communicate with each other), means less time with the patients.

3) Unrealistic expectations about change. The healthcare system in the US never integrated breastfeeding into its care. For 3 generations, hospitals promoted formula use, and separated mothers and babies. 3-5 years, which is the length of time it takes to achieve designation, is far too short a time to integrate changes in attitudes, policies, and practice. Resistance then develops; folks can feel battered or forced.

Look at Dr. Melissa Bartick’s latest article for the costs of not breastfeeding; the costs to our world, not only the US, of cancer, diabetes, and obesity. A reminder, these are data about populations, not individuals.

I would like to see evidence, case-control studies or retrospective reports that describe the health benefits of formula.

CSN0116

Nikki, you won’t address any of the things I present, you just hop to different things. Clearly, we each think that what’s wrong with hospitals, community and social supports, as they relate to bf, is very different. You’re all more support, more education, more normalization, all of which is so exhausted at this point. LCs are overworked in hospitals? Well every wic office and nearly every ped office has one. Too much info at once? Women are bombarded for 9 months with posters, pamphlets, lectures, and classes on how to breast feed.

And Bartick? She’s a fucking loon who used a simulated model of cherry picked, flawed ideals to come up with her “savings”. That study is shit and has bee ripped apart by many. I work at the same institution with one of her co authors… nobody is much impressed.

TALK TO ME ABOUT THE COSTS TO BREAST FEED. TALK to me about how the female body, and all body systems, fuck up constantly but breasts can’t. TALK to me about the cost when they do fuck up. Talk to me about the cost of perpetuating that breast feeding is “amazing” instead of inherently flawed.

You want controlled studies of formula’s benefits… for starters, look at the breast feeding studies already out there.

To my knowledge, upwards of 80% of newborns are EBF at 1-2 weeks of age. Soooo these are some pretty unfortunate findings.

KeeperOfTheBooks

Well, yes.
If parents are denied any sort of information on safe formula preparation, then it’s not entirely shocking that they, especially first-time parents, might *possibly* not prepare it correctly. (She says sarcastically.) Take me: I’m college-educated, and I’ve cooked a LOT over my lifetime. What’s just about the number one rule of baking? You add liquids to solids, right? Well, that’s how I prepared DD’s formula until I happened across a warning about that a few weeks into her life. No one told me how to mix a bottle or prepare formula, even though we were supplementing as a condition to leave the hospital due to DD’s dehydration and weight loss.
However, the BFHI solution to this isn’t “if mom/dad/whoever is caring for baby decides to formula feed, give them appropriate education on how to do so safely.” The BFHI solution, from what I’ve seen at my local BFHI hospital, is to pretend that everyone will breastfeed no matter what and not give any information whatsoever about formula, even if mom states from the start that she’ll be formula feeding. No doubt some bureaucrat somewhere can explain to me how that prevents issues with formula prep, but damned if I can see it. Hell, as I stated in another thread recently, the required educational video we had to see prior to discharge in lieu of actually talking to a nurse didn’t even mention how to bottle feed, or pump, or thaw breastmilk, or whatever: all it talked about was a) how breastfeeding is always easy and painless, and if it isn’t You’re Doing It Wrong, and b) a brief how-to on breastfeeding. Not even any mention, IIRC, of mastitis or plugged duct or abscess symptoms or treatment–no doubt they didn’t want to infringe on the breastfeeding is always easy and painless party line, or something. Frankly, if I were a nursing mom, I’d have been angered by the lack of rather vital information in that video about my chosen method of feeding. As it was, I couldn’t see why I had to sit through that drivel rather than sleep.

nikkilee

BabyFriendly guidelines require that families be taught the safe preparation of the formula they will use. Hospitals in my region are using flip charts to teach about the safe preparation of powdered infant formula, as hospitals don’t carry powdered infant formula because of its risks, despite it being the one most given by WIC as it is cheapest.

CSN0116

BFHI patronizes and requires that staffers:

1. Ask a woman why she wants to EFF or supplement

2. “Address these concerns” i.e. try to talk her out of it

3. Explain to her the dangers of formula and what her baby will be missing

4. If the woman persists, THEN she receives formula and proper preparation instruction.

nikkilee

Here is the exact wording:

“6.1 Guideline: When a mother specifically states that she has no plans to breastfeed or requests
that her breastfeeding infant be given a breast milk substitute, the health care staff should first
explore the reasons for this request, address the concerns raised, and educate her about the
possible consequences to the health of her infant and the success of breastfeeding. If the
mother still requests a breast milk substitute, her request should be granted and the process
and the informed decision should be documented. Any other decisions to give breastfeeding
infants food or drink other than breast milk should be for acceptable medical reasons and
require a written order documenting when and why the supplement is indicated. ”

There are reasons and evidence behind these guidelines. One is that corporations don’t want the truth about their product to be common knowledge. If you are interested, explore the patents behind formula ingredients, and what the companies who are applying for those patents say about them.

This is true about all corporations, tobacco being a major example. The truth about tobacco causing harm was known for decades and suppressed. GM had information about its airbags for years; it wasn’t enough enough people died or were injured that the litigation started.

It is possible to do this kindly and respectfully. I have done so. In my experience, and It is important to do it only once during her hospital stay, not every single shift!! Unfortunately, in some facilities, it happens every single shift. This is awful and disrespectful and rude, and creates backlash.

There will always be formula in hospitals with BFHI designation.

CSN0116

Like I said, patronizing.

“There are reasons and evidence behind these guidelines. One is that corporations don’t want the truth about their product to be common knowledge.”

Surely the risks of EBF are discussed as well? Otherwise it sounds like the breast feeding industry is much like the formula one you describe. Seems they don’t want the truth exposed either.

1. the ingredients in formula are safe.
2. comparing formula ingredients to a tobacco or air bag level conspiracy is ridiculous…

nikkilee

The ingredients in formula are not all safe; many are not listed on the label, MSG, for one. Hypoallergenic formulas are the highest in MSG content. Many adults choose not to eat MSG because it gives them headaches.

The formula industry uses human milk as a model, and aims to produce human milk in a laboratory. . . .they know it is the best thing for human infants.

CSN0116

Sigh…You refuse to engage in any discussion worth a damn. I’m out.

nikkilee

Thanks for the comments about Dr. Bartick. No matter what evidence is presented in this forum, it is guaranteed to be rejected, both here and out in the world.

Thank you too for the comment about the lack of studies about the health benefits of infant formula. There will never be any.

CSN0116

I said there will never be controlled, prospective studies, for the typical ethical reasons.

There are benefits to formula.

If every newborn worldwide were eff with access to clean water for preparation, morbidity and mortality would plummet… even in the US.

nikkilee

No way. EFF babies have more physician visits, more hospitalizations, and use more prescription medications in the first year of life than do EBF babies. While this study is from 1999, the results are still true. https://www.ncbi.nlm.nih.gov/pubmed/10103324

momofone

You state that as an inevitability. Anecdote: My breastfed son had one illness requiring a doctor’s visit in his first year of life. My breastfed nephew (same age) had 40, and multiple prescription medications. It’s almost as if feeding method isn’t the only factor that affects these things.

nikkilee

Yes. you are correct.

momofone

I think what was far more relevant than how they were fed is that my son is an only child whose dad stayed home with him, vs my nephew, who had an older sibling and who went to daycare so was exposed to lots of other kids. Your statement seems to neglect other possible factors.

The Bofa on the Sofa

My first son got one cold when he was 1 month old, at baptism, but other than that, he wasn’t sick at all for the first 14 months. He was EBF for about 3 months and then combo fed until he was weaned at 9 months.

Our second, who is 20 mos younger than the first, got his first cold at about 1 mo and was sick pretty much for his first two years. Also EBF for 3 months, combo fed for 10 mos, and then weaned.

The difference? Well, what happened with my oldest at 14 mos is that he started daycare.

And with the younger, he started daycare at 4 mos. However, his brother was in daycare the whole time.

A BF study that does not account for daycare attendance either by the child or by siblings is ultimately not going to be worth much.

Box of Salt

“A BF study that does not account for daycare attendance either by the
child or by siblings is ultimately not going to be worth much.”

I chose not to be employed for the full first year of both children’s lives, because my family could afford it.

Munchkin#1 was exposed to babies the same age a few times a week (play group, Gymboree or the YMCA, and cousins), used shopping car handles for teething, drooled endlessly, got the sniffles a bit, but has been seriously ill all of twice in over 12 years.

Kiddo#2 had a serious cold at all of 3 weeks old, leading us to figure out how to raise the head end of the basinette to allow for snot drainage (how are folks going to do that once they stop delivering phone books to doorsteps?), ended up needing antibiotics before starting solids, and has had antibiotic resistant ear infections more than once.

What’s the difference between the two? Munchkin started preschool when Kiddo was not quite one year old (yeah, I know that doesn’t explain all of the illnesses mentioned above. Bear with me). Munchkin had a few more URI-type sick days during preschool years than Kiddo, because Kiddo got those colds when Munchkin did. Munchkin’s only sick day since starting kindergarten happened at the start of Middle School – more kids, from different elementary schools, new germs. I’m keeping my fingers crossed that if the next school year starts off with a Middle School Plague striking the new students again, Kiddo already had it last year. But with Kiddo’s luck, I’m not counting on it. Guess which one of them had H1N1 just before the vaccine became available?

And no, nikkilee, no drop of formula ever crossed either kid’s lip.

It’s not the breastfeeding. There are other factors involved.

Sure, looking at population level data is great. But as you yourself (nikkilee) have noted, nothing in life is guaranteed. Using that data – which, for crying out loud, is still confounded! – to bludgeon women into making the same choices you made is unethical.

Azuran

You think that way just because you are refusing to look at the risks of breastfeeding.
The ‘protection’ from breastfeeding is far from perfect and generally minimal.
As such, my breastfed brother was sick all the time, with emergency visits multiple time per year. I’m formula fed and I wasn’t sick. My mother was breastfed, she’s obese, another one of my breastfed brother was also obese in childhood. I wasn’t
And without formula, I might have died, I couldn’t drink breastmilk. I was hospitalised twice because of breastmilk.
Bad outcomes with breastfeeding are something you have to take into consideration if you want to compare the 2.

Heidi

As far as I can see, the only thing it even factored in was maternal smoking and education status. It didn’t factor in income or daycare, anyone else in the household who smoked or even if other caregivers smoked (why the eff not?!), what kind of environment they were living in generally. Those are huge things not to consider. My formula fed baby has been sick never. But you know what? I’m a stay at home parent and he’s never had to go to daycare. In 1999, pumping wasn’t big nor was breastfeeding in public. I would think in 1999 breastfeeding moms were even less likely to work outside the home and were much more likely to be affluent. It was less feasible than it is to day to work and breastfeed.

I did have a lot of ear infections as a kid that “magically” quit once I was old enough not to go to my grandmother’s. I also got croup as a toddler. She was a 2 pack a day smoker who smoked indoors and in her car. My mom didn’t smoke, though, and she was college-educated. But what difference does that make if I spent a third of my day in bad air quality?

CSN0116

Are you serious with this shit? I don’t care that it’s from 1999, I care that they don’t control for socio-economic status, number of older siblings in the home, or daycare usage. This is a very poorly done study and proves nothing, which is why, 18 years later, no insurance company care about EBF.

Box of Salt

From nikkilee’s link “Children were classified as never breastfed, partially breastfed, or
exclusively breastfed, based on their feeding status during the first 3
months of life.”

Anecdata:
How do you explain my younger kid’s ear infections? Was formula somehow coming out of my breasts the second time around? Two kids, same parents, same feeding method, different experiences. It’s almost as there are other factors involved!

nikkilee

Research data comes from populations. You can do everything right and still have things go wrong. No guarantees in life. Non-smokers can lung cancer, and smokers have a much better chance.

swbarnes2

So your study did NOT correct for whether the kids went to day care or not? And you sincerely think that’s not the slightest bit relevant? Sincerely? You sincerely think that going to day care, or having siblings that go to day care or school is not at all relevant to how often a child gets sick?

Do you understand that everyone is laughing at you for thinking that day care is irrelevant here?

CSN0116

We discuss well-done breastfeeding studies here all the time, and compliment them. Unfortunately, the ones with good designs and proper controls return the most lackluster “benefits” findings. Gee, wonder why?

Bartick’s study was shit because it was shit.

momofone

“No matter what evidence is presented in this forum, it is guaranteed to be rejected, both here and out in the world.”

Does it occur to you that if your “evidence” is soundly rejected everywhere you present it, the common denominator may be the “evidence” itself?

nikkilee

Every single healthcare organization policy and public health organization recommends breastfeeding as the first option for infant feeding.

momofone

Regardless, parents are still free to make that decision, and don’t have to offer explanation or justification for it.

The Bofa on the Sofa

Absolutely. All else equal, breastfeeding is better. But all else is never equal, and in those situations, there can be other better options.

Sarah

Studies or benefits? If the former, I concur, at least in the current climate, but that tells us more about the prevailing orthodoxies and the unwillingness to consider anything that might challenge them than anything else. If the latter, prove it.

Box of Salt

nikkilee “There will never be any.”

Nor will there be a placebo controlled trial of parachutes to treat falling out of airplanes.

The “health benefits” of formula are like the “health benefits” of c-section: the baby is not dead.

nikkilee

Formula feeding has been shown to increase the risk of SIDS.

Heidi

And you are probably doing a fair share of exacerbating PPD and anxiety in women with your unfounded breastfeeding “facts.” Even if we could definitely prove it does, telling that to a woman who can’t breastfeed can be so hurtful, but you blather on anyway.

The Bofa on the Sofa

So give the kid a pacifier at night. That’s more effective than breastfeeding in reducing SIDS anyway.

Oh, and vaccinate.

Heidi

But if you give the baby a pacifier at night, where is Nikki Lee’s money?! She can’t sell you her book about “alternative medicine in breastfeeding therapy” or her services as a baby twister. She’s nothing but a greedy fear-monger.

CSN0116

This woman authors this garbage?! I thought she was just here harassing.

Heidi

I guess she believes any publicity is good publicity? I have a hard time, though, believing she’s gaining any future customers posting here. As someone who experienced an inability to lactate enough, I have no interest in her services. If some LC started shaming me about how I was increasing the chance of SIDS, setting my baby up for frequent hospitalizations and obesity, telling me formula was poison, and the cherry on top of the sundae, I was going to get breast cancer before menopause and started throwing poorly controlled studies at me to justify their abusive behavior (and I, a mere English major, can even spot the flaws a mile away), I’d tell him or her to go f*** themselves!

PrudentPlanner

Do you enjoy coming here and making yourself look foolish? Does it fill you with righteous rage? If so, you may have an addiction to anger….

“”Usually, if a person causes a fight deliberately it’s because there is
resentment, jealousy, or anger that has not been resolved. Sometimes it
is a guilt reaction, often seen among those who feel they have not been
kind”

Perhaps making silly comments on SOB not the most well-rounded way to conduct your life.

nikkilee

I come here because resistance is a teacher, and I enjoy hearing different points of view. I’ve learned here that all the evidence in the world won’t change beliefs, so I have had to learn different ways to teach. My classes have changed as a result of being here. When I have enough, I leave for a while.

Daleth

Another “nope” for ya, as in nope, it hasn’t. I love how you post random statements without even attempting to cite sources.

Box of Salt

nikkilee, oh no! MSG!

Did you have to take organic chemistry or biochemistry before you enrolled in your nursing program how ever many years ago that was? Did you forget it all since then?

MSG is not the devil. It’s an abbreviation for MonoSodiuim Glutamate.

Glutamate is an amino acid. You know, those things that make up proteins. Protein: as in your muscles, enzymes, some hormones, antibodies, and if that’s too hard to think about also your hair and fingernails.

The de-aminated (without the amino part of amino acid) compound, alpha-keto glutarate, which is derived from the gluatmate you eat, is an intermediate in the Krebs Cycle aka Citric Acid Cycle – which provides you the fuel to make the ATP that keeps you alive.

nikkilee

Many adults choose not to eat MSG because of the headaches. Chinese restaurants will sometimes advertise MSG-free on their menus. It is not a benign substance for some people.

Heidi

Actually studies have proved otherwise. It’s also a naturally occurring substance in foods like tomatoes. If I recall correctly, something like 200 people were given MSG or a placebo and all of 2 people got headaches and one of them was given a placebo. I wouldn’t bet any money that the one person got a headache from MSG.

Box of Salt

Fixing it for you: “Many adults choose not to eat MSG because” they don’t understand chemistry or biology.

Back in high school, I used to think something in Chinese food gave me the giggles. Then I realized the giggles happened when I went out to eat at the Chinese restaurant with my friends, and if I ate the same dish at the same restaurant with my family I didn’t get giggly. It wasn’t MSG giving me giggles – it was the fact I was a teenaged girl hanging out with other teenaged girls.

nikkilee

I just looked up umami; the term refers to a taste. Umami is one of the 5 basic tastes: sweet, salt, bitter, sour and “pleasant savory.” Naturally occuring glutamates are different to MSG. Generally, umami taste is common to foods that contain high levels of L-glutamate, IMP and GMP, most notably in fish, shellfish, cured meats, mushrooms, vegetables (e.g., ripe tomatoes, Chinese cabbage, spinach, celery, etc.) or green tea, and fermented and aged products involving bacterial or yeast cultures, such as cheeses, shrimp pastes, fish sauce, soy sauce, nutritional yeast, and yeast extracts such as Vegemite and Marmite.

Many humans’ first encounter with umami components is breast milk. It contains roughly the same amount of umami as broths.

Heidi

Again, no. “The glutamate in MSG is chemically indistinguishable from glutamate present in food proteins. Our bodies ultimately metabolize both sources of glutamate in the same way. An average adult consumes approximately 13 grams of glutamate each day from the protein in food, while intake of added MSG is estimates at around 0.55 grams per day.”

maidmarian555

Huh? Breast milk (and indeed formula) is full of lactose. It’s very sweet (which explains why most babies will invariably go for apples/pears/fruit in general over vegetables once you start attempting to introduce solid food). Umami could not in a million years be used to describe the flavour of infant milk. Sorry. My boobie milk and the formula I mixed for my son tasted nothing like fishy broth or marmite. If your own breast milk tastes like that I suggest you get to your doctor asap.

nikkilee

Containing glutamate is not the same as tasting like glutamate.

maidmarian555

Well I’m aware of that. You were the one saying breastmilk contains ‘umami components’. Umami always refers to the taste of a food (as far as I’m aware anyway). Your statement appeared to be suggesting that breastmilk was somehow broadening the palates of our children. It’s not. It’s sweet. Not a 3-course meal prepared by a Michelin starred chef.

Nick Sanders

MSG is a naturally occurring glutamate.

Box of Salt

nikkilee “The formula industry uses human milk as a model, and aims to produce
human milk in a laboratory. . . .they know it is the best thing for
human infants.”

Yup. No one is disputing that. Where we disagree is whether it should be promoted as the only acceptable way to feed a baby, as it is in the US these days.

Having interacted with you on this website for a number of years, I understand why you hold your personal almost religious attitude about the importance of breastfeeding. I will also commend you from backing off the “formula = poison” stance you promoted a few years ago.

That said – get a grip! We have to stop overselling it. Deal with the confounders in the research. Middle class breastfed kids aren’t smarter than the poor kids because they were breastfed. It’s because the middle class parents could afford to spend more time helping their kids develop the skills that allow them to appear (as testing goes) smarter. And you can’t declare them healthier just because they weren’t exposed to as many viruses in their early days as their daycare counterparts.

Breastfeeding is great. It’s not magic, and it’s not a panacea.

Every family needs to do what works best for them. Regardless of what you, nikkilee, think that is.

fiftyfifty1

“The formula industry uses human milk as a model, and aims to produce human milk in a laboratory. . . .they know it is the best thing for human infants”

Actually no. Scientists developing formula use human milk as a model for many aspects of formula, but not all. For example human milk lacks sufficient amounts of some nutrients (e.g. vitamin D, K, iron). This is corrected in formula.

nikkilee

Human milk has sufficient iron, bound to a protein; this is lactoferrin. It is 100% bioavailable. More iron is in formula than infants need, because the form it is in is difficult to absorb. A shotgun approach. If mamma has enough vitamin D in her diet (as most of us don’t get enough from the sun anymore, her milk will be sufficient.

fiftyfifty1

“Human milk has sufficient iron, bound to a protein”

This is a lactivist myth right from the lactivist script. If it were true, I wouldn’t see iron deficiency anemia in any of my 100% breastfed baby patients, and yet I do.

“More iron is in formula than infants need, because the form it is in is difficult to absorb.”

Also a myth. The amount of iron in formula is the correct amount, the bioavailability is factored in.

“If mamma has enough vitamin D in her diet (as most of us don’t get enough from the sun anymore, her milk will be sufficient.”

Yet another myth. But even if it were true, what’s your point? It’s cold comfort to a breastfed baby with rickets, no?

Delayed cord clamping is beneficial overall in preterm infants. In term infants there is a trade off between increased rates of jaundice and slightly increased iron stores (which still may not be enough to last a breastfed infant until it is taking in enough iron-rich solids).

In any case, I see that you are backtracking. You previously wrote “Human milk has sufficient iron, bound to a protein; this is lactoferrin. It is 100% bioavailable.” Now all of a sudden you agree it may NOT sufficient.

nikkilee

Delayed cord clamping is of benefit to term infants too, as stated in the ACOG recommendation.

Human milk has not been iron-sufficient for breastfed babies, when babies have lost the extra iron they should have received at birth by the cord being cut too soon. Not a fault of the milk; a fault of the maternity practice. Cord cutting timing has been a topic of debate for 30 years; ACOG finally got on board.

fiftyfifty1

You say that breastmilk is not iron deficient, but then say that the cord is cut “too soon” then it is. So in your role as a LC are you asking all women about the timing of cord cutting? And warning all women with early cutting or unknown timing that breastmilk will contain insufficient iron and telling them they must supplement?

Daleth

If mamma has enough vitamin D in her diet (as most of us don’t get enough from the sun anymore, her milk will be sufficient.

Nope. My IVF clinic kept testing my blood levels of vitamin D (I went to an excellent clinic, CCRM–they cover all the bases) and no matter what I ate, it wasn’t sufficient. Even Vitamin D3 pills with 1000mg in them didn’t work. What finally got me out of the below-normal range–and this took many months–was Vitamin D3 suspended in oil, with each drop containing 4000mg (this stuff: http://www.carlsonlabs.com/p-293-super-daily-d3-4000-iu.aspx).

And as you point out, most of us are deficient in vitamin D. Which is why exclusively breastfed babies are at risk for rickets:

Unless mama is supplemented. . . Dr. Carol Wagner has published on this, based on her research in South Carolina. I also saw it in a pediatric text from 1972, to supplement the mother. Most of us need to be taking Vitamin D supplements; it plays a role in increasing risk of cancer, cesarean section, and diabetes, Lots published on this.

Daleth

Unless mama is supplemented

As I said in my post, I was taking supplements–1000mg pills (that’s 250% of the RDA) of vitamin D3, the most bioavailable and effective kind–and they didn’t work. My blood levels of VitD were still well below normal.

I hear that you wish breastfeeding were simple and 100% good and risk-free, but surely you know when you’re honest with yourself that it isn’t.

nikkilee

Generally, it is. . . otherwise homo sapiens would not have survived all these hundreds of thousands of years. Specifically, there are always variations. Generally, breastfeeding works.

Nick Sanders

otherwise homo sapiens would not have survived all these hundreds of thousands of years.

Haha, nope. All that’s needed for the species to survive is for at least 2.5ish kids per pair of parents to make it to adulthood and have kids of their own. Less if one man gets multiple women pregnant, since then there’s not a 1 to 1 requirement for reproduction.

The modern trend of having just a few kids is not the historical norm. Until very recently parents would have tons and tons of kids, hoping a few would make it to adulthood.

The invention of formula in the 1860s was the first time most babies could survive without breastmilk. Before then, most babies died that didn’t receive it. This is the reason that wet nursing was an honored profession.

Nick Sanders

So, breast feeding doesn’t work all that well after all?

The Bofa on the Sofa

Generally, it is. . . otherwise homo sapiens would not have survived all these hundreds of thousands of years

Historically, “generally” it has been 8 kids per woman, with 5 reaching adulthood. That is what happened “generally” over these hundreds of thousands of years.

That’s more than enough for a species to survive. But I don’t consider that acceptable. “Evolutionarily sustainable” is neither necessary nor sufficient in evaluating a current practice.

Daleth

Humanity’s survival is not the same thing as your or your baby’s survival. Humanity can survive just fine with 1/10 of all babies and 1/100 of all mothers dying in or just after labor. After all, that’s what humanity did for all these hundreds of thousands of years.

But these days most people are interested in ensuring that THEY PERSONALLY survive and so do their own personal babies. Not just a sufficient number of babies to keep the species going.

Sarah

Humanity can also survive well enough with a lot of us being Vitamin D deficient: after all, this is what is happening now and we don’t seem to be disappearing. It’s just not optimum. Breastmilk and breastfeeding doesn’t need to be anywhere near perfect for enough of us to survive long enough to reproduce enough. That’s actually not that high a barrier.

nikkilee

Yes. you are right.

Daleth

The upshot of this is that the fact humanity is still around and generally thriving does not mean breastmilk is perfect or even optimal. It just means it’s good enough to keep most babies alive.

And I’m not knocking breastfeeding here. Just pointing out that humanity’s existence tells us nothing about breastfeeding other than that generally most babies get enough milk to survive.

Roadstergal

Seriously? “Survival as a species” is your standard? Because it’s a really, really low bar.

Not just in terms of percentage of surviving live children, as addressed below (it can be pretty dishearteningly low and still allow for species survival), but – speaking as a 40-year-old woman who is alive at all at an above-natural lifespan, in the sort of health that is absolutely not necessary for the survival of the species – that bar is 100% unacceptable to me. I demand more.

Heidi

You gotta love how she claims it’s simple yet she IS a lactation consultant. It’s evidently not simple enough! Not only that, but she wrote a book about “breastfeeding therapy.” Surely, if breastfeeding were so easy there wouldn’t be a need for MORE lactation consultants, which NL claims the current ones are understaffed and overworked.

Nick Sanders

the health care staff should first explore the reasons for this request

Even though it’s none of their business.

address the concerns raised,

There aren’t “concerns”. It’s a decision.

and educate her about the possible consequences to the health of her infant and the success of breastfeeding.

There are none of note.

So, effectively the official policy is that they should be meddling busybodies who harass people for making a decision the policymakers disagree with.

nikkilee

It is a healthcare decision. . . how an infant is fed has an impact on the future health of mothers and babies. The public is generally unaware of that. The healthcare risks are serious enough that folks have the right to know. .. and the right to choose what will work for them. Both things are true.

CSN0116

They’re unaware because it’s not real.

Why aren’t the risks of breast feeding, especially if mom wants supplementation for underfeeding concerns, part of the protocol?

Big Tobacco much? C’mon, Nikki. Even you have to see the hypocrisy here!

nikkilee

The only difference is that folks don’t have to smoke. Babies have to be fed.

It is the risks of insufficient breastfeeding that are the problem; breastfeeding is the way mammals feed their young and has eons of years of evolutionary success. Not to individuals, you or me, but to the species. Breastfeeding can be insufficient for maternal reasons (lack of knowledge, lack of support, lack of physical necessities (anatomy or hormones); infant reasons (prematurity, sickness, congenital anomalies); and a combination of both.

The word “insufficient” was first used by Dr. Lawrence Gartner, AAP and ABM pediatrician, when ha spoke about “lack of breastfeeding” jaundice, the condition that results when newborns aren’t getting enough breastmilk.

CSN0116

So, lactivism can’t engage in intentional fact-hiding conspiracy because infant feeding is necessary? So does that mean that there is no intentional fact-hiding (completely false)? Or that it’s justified?

Of course infants must be fed, but they sure as shit don’t have to be breast fed… so I further fail to understand.

YES! The risks of insufficient breast feeding are indeed a problem! Success at last!

And you talk evolution? Babies died in droves from breast feeding and the species continued existing regardless. Far from every baby has to survive breast feeding for the species to endure. What kind of a point is that to make anyway?! If anything, evolution tells us with certainty that babies should be dying from breast feeding’s flaws.

Shall we let them die, or just be casually maimed with starvation dehydration in these modern times, even though we know better and have magnificent science milk to spare them? BFHI, lactivism and people like yourself support maiming them at the alter of breast feeding. They are but collateral damage to a worthless cause that produces EQUAL outcomes to the alternative – formula.

maidmarian555

Oh eff off. Today, formula is an excellent source of nutrition for babies. Please do tell me what I was supposed to feed my infant son when he started refusing the breast and consistently biting me from 5 months old? Other than formula. Which he is thriving on and gaining more weight on than he ever did from breastfeeding BTW. You’re comparing current feeding methods to those of the Victorians (where many children died from being fed raw milk laced with Borax). We’ve moved on a bit in the last 150 years or so. Moron. We’re not just ‘mammals’. Human beings are medically advanced way past our mammalian cousins. I’m not equivalent to a dog or cat. Or hamster.

Sarah

You should’ve given him cigarettes to dull his appetite. Anything to avoid formula.

maidmarian555

Oh and nobody gives a shit how you prepare formula in BFHI hospitals. I combo fed from day 1. I got a single pamphlet from my Health Visitor on formula prep. Roughly 8 midwives wanted to see me breastfeed. Nobody (not even the midwives that came to my home) gave two shits about how I prepared formula. Nobody checked I was sterilising bottles or preparing it correctly.

“Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”

So there are associations with breastfeeding and infant and maternal health outcomes, there is not evidence of cause and effect.

You have failed to provide evidence of harm. Your statement from above is untrue and unfounded:

“how an infant is fed has an impact on the future health of mothers and babies.”

Sarah

There’s a reason why they’ve been rejected, though. Because they didn’t sufficiently back up your claim. That’s your fault and nobody else’s. If you don’t want to do this again, stop making claims you can’t verify.

In regards, to type 2 diabetes and metabolic syndrome, I thought those were more likely to cause lactation failure to begin with? Also women with PCOS, metabolic syndrome, type 2 diabetes, etc.(that is conditions that contribute to lactation failure) have a harder time taking off weight.

momofone

If I am the parent, it is MY healthcare decision, and I am not obligated to offer explanations or to engage in discussion about it.

nikkilee

Informed consent is part of the paperwork signed when one receives care in a hospital; in maternity, that includes information about lots of things. Folks can refuse.

momofone

Yes, I have experience with informed consent.

moto_librarian

No, breastfeeding does not have any demonstrable impact on health beyond the first year of life. We’ve talked about PROBIT plenty of times. You should know that the only effect of breastfeeding was an 8% reduction in colds and episodes of GI illness in the first year, and the latter “benefit” may no longer exist now that we have widespread uptake of the rotavirus vaccine. There are no well-designed studies that demonstrate any impact on IQ, asthma, allergies, obesity, etc. as a result of breastfeeding. The BFHI is a policy based on junk science. It needs to end.

RudyTooty

“the health care staff should first explore the reasons for this request, address the concerns raised, and educate her about the possible consequences…”

So paternalistic.
Actually, too paternalistic for my taste.

What legitimate reason do I have as a health care provider to deny any patient this choice? NONE.

Daleth

4. If the woman persists, THEN she receives formula and proper preparation instruction.

4(a): If she’s lucky.

Empress of the Iguana People

Funny, neither hospital I gave birth in told me anything about formula, despite being BFI. Not even for the kid who they knew would be fed formula.

Heidi

But why not make sure all mothers and primary caretakers know how to properly prepare formula? We have no idea what challenges a woman and her baby may face after leaving the hospital and we can’t just assume she will have access to the information about preparing a bottle.

Now the more I think about it, the angrier I am that formula samples are no longer given at the hospital. My baby was born in December when weather could have affected our ability to get formula. But who cares?

CSN0116

“But why not make sure all mothers and primary caretakers know how to properly prepare formula? We have no idea what challenges a woman and her baby may face after leaving the hospital and we can’t just assume she will have access to the information about preparing a bottle.”

I believe we call that “undermining” breast feeding.

sdsures

What risks might those be?

Heidi

Ready to feed is carried because it’s time saving and more convenient, and it takes NICU babies into consideration, too. Buying one kind of product that can serve the needs of all babies is easier than carrying multiple kinds of products. RTF is in a disposable bottle and is sterile. (Human nipples aren’t sterile and I never even attempted to sterilize my boobs when I was breastfeeding, even in the hospital. Human milk is a great medium for pathogenic bacteria to grow in, too which is why banked milk is also pasteurised.) We don’t tax a hospital with bottle washing, heating water and mixing formula when the water is 160F then letting it cool to under 100F to ensure near sterility which is more needed for low weight and premature babies. The RTF bottles can be easily kept in the patient’s room for whenever the baby is hungry. Imagine a nurse having to go through all the steps with powdered formula for every hungry baby. At home, you usually have one baby and one kind of formula. You can make a day’s worth at one time using the more cautious method if you want or need to and store it in the fridge covered.

ICUs have gone to disposable wipe baths, for example, as opposed to other forms of bathing because of the germs present in a hospital. Staph and other things were found to be growing in those plastic tubs used in bed baths. But to say taking a shower or bath is very risky for most of the population is a bit ridiculous.

swbarnes2

You have to be a liar to be insinuating that Hypernatremic dehydration happens anywhere as often in formula fed babies as in breastfed babies. Google barely turns up anything when you looks for the subject. But breastfeeding associated dehydration gets lots of hits.

Anyone hoping to intelligently speak about this issue has already read these papers. So either you have read them, and are dishonestly ignoring them, or you have not read them because you are dishonestly avoiding evidence that you don’t like.

In this study 24% of the control babies were formula fed, only 2% of the dehydrated cases were. That’s an OR of 11.4. That’s a huge protective effect for formula feeding. If there were any medical situation ever recorded for which breastfeeding had such a profound protective effect, lactivists would be talking it up 24/7.

Nikki, your utter silence on this point will be taken as evidence that you know perfectly well that there is no such condition.

Nikki, your silence about all this evidence will be taken as evidence of your fundamental dishonesty.

nikkilee

Is it alright in our discussion to use a study that is 12 years old, as the JAMA one that you cited?
That 2005 study found an incidence of 2.1/1000, a number far from 1 in 25. The conclusion was that there were 2 risks for admission, one being a first time mother and the other exclusive breastfeeding.

“In literature, this incidence was reported by
Oddie et al.23 as 2.5/10,000 live births, by Harding et al.24 as 1.7, and by Konetzny et al.13 as 6/1,000 live births. In literature,
hypernatremia frequency among breastfed term newborns
was reported to be between 1.9% and 4.1%.8,25,26
Similar to the literature, in the 5 years of study that we have
conducted, the frequency of hypernatremia among the term
infants who were born in our hospital was 7 in 1,000 live
births and the ratio of infants who developed HD related to
breastfeeding among the infants who were admitted to NICU.”
was found to be 3.1%.”

“In various studies, mother’s being primipara and having a cesarean section are considered as the most important risk factors for the development of HD”

(NL here: in many studies, cesarean section was found to delay the onset of milk volume increase. . . perhaps cesarean section is more of a risk more than was previously thought?)

The authors of this study found there was no correlation between mode of delivery and HD. This is different to some studies, and validates the findings of others.

The authors conclude, “We believe that neonatal HD could be prevented by education, breastfeeding support, and close monitoring.”

Heidi

Similar to the literature, in the 5 years of study that we have conducted, the frequency of hypernatremia among the term infants who were born in our hospital was 7 in 1,000 live births and the ratio of infants who developed HD related to breastfeeding among the infants who were admitted to NICU was found to be 3.1%.”

So If I’m reading that correctly, overall, a baby has .7% chance of hypernatremia but if they are breastfed, they have a 3.1% chance. Maybe I’m not reading it correctly.

And nikki lee, it would be hard to ever draw conclusions about c-sections causing milk delay. Women are more likely to need C-sections if they are older, if they had some sort of diabetes, if they sought fertility treatment (and not that the fertility treatment itself causes it but the reasons that fertility treatment was sought), and these risks also contribute to lactation problems and failure.

By the way CSN said, “some 1 in 25 EBF newborns are readmitted to special care for starvation-related issues like hyperbilirubinemia and dehydration,” that’s 4%, which isn’t far off from 3.1%, but also notice, she stated starvation-related issues, not just hypernatremic dehydration.

nikkilee

Unfortunately, cesarean sections are done for convenience too. About half of all first time mothers who are induced will end up with a cesarean section. Do a google search for “pit to distress” to learn what some physicians do. Cesareans are done because the art of delivering a vaginal breech ( complete and frank) has disappeared. I worked in L&D for years, and saw many scary things, like residents doing unnecessary interventions for practice, (the assistant director of nursing at that hospital used that exact phrase) and not because laboring women needed those things. The ADN said that physicians needed to practice so they would know how to take care of women once they finished their residencies. As for stress, Dr Laurie Nommsen-Rivers and others in California showed how stress delays the onset of milk volume increase in more than one published paper.

Azuran

Considering that overall, around 75% of women have vaginal birth, Vaginal birth is far from a disappeared art. (And it’s not actually art)
And c-section are hardly done for convenience. I sure as hell NEVER find it convenient when one of my patient suddenly needs an emergency surgery. Emergency surgery means overtime, skipping lunch, more paperwork, longer hospitalization, more monitoring, more risk of complication.

nikkilee

Many physicians prefer the control offered by a cesarean section, as it means less deliveries at night and on weekends. I don’t know what is the percentage of emergency versus non-emergency cesarean sections. The most recent CDC statistic for national cesarean section rate is from 2014, when it was 32.2%.

Azuran

Well of course, if they know a woman will need a c-section, they will do it during the day and during the week. That’s when you have to most staff around to help in case of emergency. There’s nothing ‘evil’ about this.
Same thing if a woman needs an induction. They will schedule it during a day of the week, because that’s when they have the staff.
But Doctors don’t just randomly schedule c-section and induction without any medical necessity. They do so for women who need them. Those who don’t just show up at the hospital whenever their labour starts.

Funny, I wasn’t offered a c-section, I wasn’t offered an induction either. I’m just expected to show up at the hospital when my labour starts. Unless I develop a complication, Induction isn’t even considered before 41-42 weeks. And it’s not done for convenience, it’s done for the baby’s safety. The same thing happened to all of my friends and colleagues who had babies.

nikkilee

What you describe is not true everywhere. The CDC identified medical intervention (about a decade ago) as one reason for the increasing rates of prematurity; this lead to the development of stay pregnant for 39 weeks campaign started by the March of Dimes.

Daleth

There are two big problems with the 39 weeks campaign you mention: (1) most people don’t realize it applies only to singletons, and (2) most don’t realize it applies only to uncomplicated pregnancies.

For instance, twins are better off being born later preterm or early term–and by better off, I mean their chances of DEATH (euphemistically called “stillbirth”) skyrocket if you stay pregnant longer, whereas the risks they face from being early preterm or slightly premature are minimal in comparison.

And when I say most people don’t realize, I mean even some medical professionals. I was under the care of maternal-fetal medicine specialists for my twin pregnancy, but my insurance provided monthly calls from a nurse to help me “stay healthy,” and that goddamn nurse, who had never met me or seen my chart, tried hard to persuade me that I should defy my doctors and try to stay pregnant to 39 weeks. I had to tell her pretty forcefully that my doctors and every study I’d seen said she was wrong (Me: “Are you experienced with mono-di twins? Have you had patients carrying mono-di twins? Do you know what the recommendations are for them?” Her: “Well… um not… specifically…” Me: “Do you even know what mono-di twins ARE?” Her: “I mean… um… so, specifically, I’m not familiar…”).

ACOG recommends the following (this is about multiples with no other complications–twins with any complications have even earlier recommended deliveries):
– Di-di twins (all fraternal twins and about 1/3 of identicals): birth in week 38 (38w0 to 38w6/7)
– Mono-di twins (2/3 of identicals–they share a placenta but have their own amniotic sacs): birth between week 34 and week 37 (34w0-37w6/7); I’ve also seen multiple studies suggesting that week 36 is the sweet spot for such twins.

And of course, mono-mono (twins sharing both a placenta and an amniotic sac) are a whole different ball game; they have an extremely high rate of intrauterine death, because in addition to all the risks of twins who share a placenta, it’s also terribly easy for their umbilical cords to get tangled since there is nothing separating them. They are generally delivered by c-section between weeks 32 and 34.

As you can see at that ACOG link, pregnancy complications also change the guidelines. Did mom ever have fibroid surgery or a classical (vertical incision) cesarean? She should deliver late preterm/early term because she has a high risk of uterine rupture otherwise (and that could kill her and the baby, or more likely, kill the baby and make her need an emergency hysterectomy to stop her from bleeding to death). Does the baby show signs of growth restriction? Did mom have a premature rupture of membranes? Does mom have preeclampsia? (Even *mild* preeclampsia means you should deliver upon diagnosis if you’re at least 37 weeks along). Does she have poorly controlled diabetes? Etc.

So I have to wonder… how many babies have been killed by the 39-week rule, and more generally the concept that “the longer they bake the better”? There was a woman in my Facebook group of mono-di twin moms who pushed to stay pregnant as long as possible because she believed that crap. At 38w3, I think it was (sometime in week 38 anyway), one day after a perfectly normal and healthy BP scan, another scan showed that one of her twins had died. They did an immediate c-section to try and save the other–when twins share a placenta, their circulatory systems are often connected so the death of one kills the other too–but he had already suffered severe brain damage.

nikkilee

Your points highlight the importance of individualized care. The 39-week campaign is a reaction to routine induction, something my clients and patients have received for the past 30 years. Every intervention has its value in a specific circumstance; because something is life-saving in one situation does not mean it is life-saving in every situation. Induction for true medical reasons is an example; induction because “you’ve been pregnant long enough” (told to some of my clients) or “it’s hot” or ” the doctor you want is off the week you are due” or “my mother is off work this week, so let’s get the baby born” are not medical reasons.

Daleth

“Life-saving” isn’t the only good reason to induce (or to opt for any other medical procedure). The overwhelming majority of medical options we choose, in labor or in everyday life, are not life saving. Most of them improve quality of life, prevent or reduce pain, preserve certain body parts or function that we want but don’t need (root canals preserve teeth that would naturally die, for instance), and so forth.

Is there any reason other than sexism that you think different criteria apply to women’s choices about medical procedures during labor or postpartum?

And many women think the non-medical reasons you cite are very good reasons. “The doctor is off the week you’re due” is a great reason to induce for a woman who really likes and trusts her doctor, or any woman who doesn’t want to have her labor attended by a total stranger. “You’ve been pregnant long enough” may mean “I’m at 39 weeks already and every ultrasound so far indicates the baby is big–ultrasound’s not an exact science but I really don’t want to risk being torn from stem to stern by letting the baby grow another week or three.” And “My mother is off work this week” is also a great reason for someone who wants help with the baby and can’t afford to pay for it.

And those reasons are none of your business. It’s not your place to judge why a woman wants to induce any more than it’s your place to judge why a woman wants to have an abortion. It’s her body–lay off.

momofone

“My mother is off work this week, so let’s get the baby born” is completely valid and reasonable for someone who has to take child care for older children into consideration. Medical reasons are certainly important, but so are practical concerns.

Roadstergal

“You’ve been pregnant long enough”

And in your world, this is a bad reason to induce? The fact that the baby is now term, and staying inside longer will either mean the placenta is starting to fail, or the baby is getting bigger with no outside-survival advantage?

You’re telling your clients this shit? You are causing, at the very least, unwanted C-sections (as per the data above), more troublesome births (dystocia and tearing from bigger babies), and possibly even disability and death to the babies in question.

Are you proud of that?

maidmarian555

Here in the UK, they won’t induce until you’re at least 11/12 days past due. And that’s the *start* of induction. I went in on 40+12. Wee man wasn’t born until I was 40+15. Admittedly via section for CPD but when I see these people talk about how my section was probably my fault for having an induction in the first place (and an epidural after 3 f*@king days of contractions) I wonder just how long they think I should have waited for…..I mean, what *is* the solution if not induction? Was I supposed to stay pregnant forever?!

Azuran

Most of those are actually mother’s request.

If a women WANTS to give birth with a specific doctor, what’s wrong with her asking to be induced in the week that her doctor is there?
If a woman WANTS to give birth when her mother will be there to help her, what’s wrong with that?
If a woman is at term and tired of being pregnant, what’s wrong with that?
And if a woman is going past term, knowing that after 40 weeks, you only increase the risk of your baby dying, and the risks of complication during birth, what’s wrong with recommending induction?

nikkilee

Because, in healthy circumstances, babies do better when they start labor. However, as long as I am not forced to induce when someone thinks I should, no problem.

Azuran

And induction causes labour. So you can’t even say this is about babies not experiencing labour (which is overall pretty insignificant in babies health. the only difference between uncomplicated VB and elective c-section is a slightly higher rate of light, temporary respiratory problems. Not anything to be overly worried about.)

maidmarian555

But when *should* an induction take place then? How long should a woman leave it before concluding that maybe baby doesn’t know best? It’s not right to tell women that they shouldn’t have inductions “too early” but then be totally vague about what “too early” actually means. How would any first-time mother have any idea when the time to do something about a non-appearing baby is based on that advice?

nikkilee

If there are true medical reasons for induction, then the risks outweigh the benefits: mother has preeclampsia or toxemia, infection, placenta detaching, maternal medical issue, baby stopped growing. These are different to convenience reasons: my mother is available this week, my doctor is going out of town, it’s hot, I am miserable being pregnant. March of Dimes describes it well. http://www.marchofdimes.org/pregnancy/why-at-least-39-weeks-is-best-for-your-baby.aspx

maidmarian555

But how would mum know that any of those things are happening? I thought I was having Brixton Hicks for 2 weeks before my induction. Apparently not. My labour kept trying to start but my big-headed son was not moving through my pelvis so no dilation. No dilation after 3 days worth of induction either. How would anyone have known what my problem was without putting us through that induction? How many more weeks should we have waited? Should I have left it until we were both dead?

maidmarian555

And I was miserable being pregnant from about 30was FYI. I guess by 40+12 wasn’t enough misery, just me being selfish…..

momofone

I think convenience is a huge reason to deliver according to the mother’s choice if her OB is on board. Practical concerns do not disappear because of magic baby dust. If I have older children and need child care, and my mother is available to provide it, that’s a win. If I want my doctor (which, for my own reasons, I did), that is a valid reason to deliver. If I want to be able to choose or avoid a particular birthday, so be it. Barring medical obstacles, why should someone not be able to choose to give birth at a more convenient time?

maidmarian555

Also, you still ducked the ‘when’ question. When should a mother with a ‘text book’ pregnancy submit to an induction. Saying that she should only go through an induction if ‘medically indicated’ is absolutely dodging the question I asked you. How late should she leave it? At what point would *you* suggest that her child and indeed her own life might be at risk if she is not induced? 42 wks? 43 wks? 44? 45?!

nikkilee

That is a decision left up to the woman and her provider. I made my own choice based on my baby’s reactivity during regular CSTs and biophysical profiles.

Azuran

Really, what are you even trying to argue here? Everyone here supports patient autonomy. No one here thinks a woman should be forced to have an induction or a c-section. We all think that they should be informed of the various possible treatment options, the risk/benefits of all of those and allowed to make their own decision.
Seems to me you are just mad because the vast majority of women make choices different then your own.

maidmarian555

So on the one hand, you say that women shouldn’t trust their providers because they’re all too quick to induce labour so that they can go and play golf at the weekends but on the other you say mothers should make a decision on when to have an induction based on consultation with their provider. Do you not see how problematic your statements are? If a mother trusts her provider and ends up having a c-section after an induction, well that’s her fault. If she doesn’t trust her provider and then leaves intervention too late, well that’s her fault too. You have no damn business going around making these statements about how bad induction is if you can’t take any responsibility for the fact that someone could listen to what your saying (and you’re a nurse so there is potentially some gravitas to your words) and end up with a terrible outcome. You know as well as I do that the longer a mother goes past term, the higher the risk of a bad outcome. If somebody goes several weeks past term then that’s a “true medical indication” for induction, whether you add it to your list of acceptable reasons or not.

nikkilee

Breastfeeding is only one of many factors influencing health: there is diet, there is activity, there is screen time, and there is formula feeding. All of these things together play a role in the global epidemic of diabetes and obesity. Having a discussion here, between educated people, and what I suggest to clients and folks in childbirth class are two vastly different things.

maidmarian555

Oh really? This is your blog isn’t it? And this post is you talking about how you imparted advice about babies ‘knowing when they should be born’ to a total stranger you overheard, no?

So it doesn’t look like there’s much difference from what you’ve been saying here to what you say elsewhere. In addition, if you’re giving advice that runs contrary to what you believe, wouldn’t that be unethical? Isn’t that patronising the mothers you work with, making the assumption that they’re not educated enough to have these discussions about their own babies?

Anj Fabian

If that was an IVF pregnancy, then it is at higher risk than a plain vanilla pregnancy. I wonder if know it all Nikki knew that?

If she did, she’d probably still shoot her mouth off about NICU like it’s a special hell for families and not highly specialized care for wee babies.

Heidi

It doesn’t even sound like NL knew how far along the baby was. My mom got a C-section at 36 weeks with my sister, which is a little early but the benefits definitely outweighed the risks. Both of us were actually born at 36 weeks (I guess I knew when to be born! I tore right through her cerclage never even giving her a chance to get an epidural, probably further damaging her cervix.). She didn’t need help getting pregnant exactly but she had to have an abdominal cerclage to stay pregnant with my sister. Also given that she had lost two children, at 21 weeks and 23 weeks pregnant, I don’t think a doctor wanted to risk a hemorrhage by waiting around any longer. I was only in the NICU for blood sugar reasons (she was taking the GTT when she went into labor and I was born very, very quickly so I’m sure the GTT contributed to my blood sugar issues, especially if my mom had GD), my sister never needed NICU. But if we had needed NICU for breathing issues, it’s better than being dead or severely injured from the consequences of waiting.

Heidi

I just read her little interaction with two total strangers who was NOT the pregnant mom, meaning she has no idea why a mom might have needed help to get pregnant or what that even really meant. What a presumptuous piece of crap. She probably doesn’t try this crap in her real job, not her side jobs of hair lights and homeopathy, because then she knows her feet would be held to the fire. But she knows if this woman goes against her doctor’s recommendations and then she has an injured or dead baby, there’s almost zero chance anyone could pin it on her. Not that I ever had a morsel of respect for NL because she goes crickets when she’s backed herself into a corner or she just spouts out something that totally had nothing to do with a valid criticism of one of her fanciful beliefs, but for me, this just takes the cake.

nikkilee

The CDC identified “medical intervention” as a reason for the increase in prematurity in the US. The public doesn’t know that. The public can think that labor is like a light switch, that can be turned off and on at will; sometimes there can be little consideration of the impact on the baby. There are consequences from that attitude. I asked questions; different than giving advice. And, like here, the forum or blog is the property of the author. Yes, I did interject, to open the door to discussion; the women were responsive. .

Azuran

Have you wondered about what intervention caused those prematurity or why they were done?
There are multiple medical reasons to want a baby to be born pre-term. That doesn’t mean it’s a bad thing by itself.
Doctors are not doing pre-term induction or c-section for fun. They are doing them to save babies. Like in the case of twins, eclampsia and many other health problems.

nikkilee

Not ever cesarean section is done for the benefit of the baby. I’ve posted some of those links already.

Dr Kitty

And so what if it isn’t?
If the CS orninduction is done for maternal benefit, or just maternal preference?

If it is what the woman wants, would you deny her that choice?

Roadstergal

Scratch the surface of a NCBer/lactivist, and isn’t it interesting how often you reveal a misogynist?

Dr Kitty

This particular flavour of misogyny:

“Women just need to be educated to make the right choices!”
“Ummm… I read all your educational materials and I’d still prefer to make a different choice”.
“Women must be legally prevented from making the wrong choices, because even when you educate them, they still can’t be trusted to do the right thing (stupid, selfish whores) !”

Azuran

And those aren’t done on premature babies.

maidmarian555

You said:

“That is a decision left up to the woman and her provider.”

And yet I found an example of you interfering and offering unsolicited advice to a relative of a pregnant woman when you DID NOT KNOW THAT WOMAN’S INDIVIDUAL CIRCUMSTANCES. How on earth could you know what conversations that mother had had with her care provider? How could you know without even speaking to her what her level of knowledge was? How dare you recruit her relatives to spread dogma that could have been harmful to her. And the worst bit? You KNOW this. You have a medical background. That’s why you keep dodging direct questions here from people. You KNOW what you’re saying is unethical and potentially harmful when applied to individual cases.

nikkilee

This is a forum that doubts all the evidence I have offered, and one that has not been able to offer one piece of evidence that there are health benefits to formula feeding. We are disagreeing. That’s alright; that’s part of dialogue.

Azuran

Benefits of formula?
-Mother doesn’t want to breastfeed
-People other that the mother can feed the baby
-Some babies can’t have breastmilk
-Some mothers don’t have enough breastmilk
-Some babies can’t properly breastfeed.
-Avoiding all the nipple bleeding, pain, mastitis etc.
-Avoiding exposition of medication through breastmilk.
-Avoiding certain diseases that can be transmitted by breastfeeding.
-Lower rates of rehospitalisation for dehydratation in the days/weeks following birth.
-Lower rates of failure to thrive.

Heidi

Maybe not in your ableist, exclusively heterosexual, privileged, gender normative world, but the world I live in, where not all women can breastfeed whether physically, mentally or financially, where people open their doors to non-biological children and adopt them, gay or straight, and many, many other reasons breast milk is not available, formula is a huge health benefit. The health benefit of not starving and getting a wholly appropriate substance that provides essential nutrition.

maidmarian555

You are damn right that I disagree with your insistent peddling of potentially harmful misinformation. I was talking about your comments on induction. You come back with some twaddle about formula. If you can’t answer the questions I actually put to you then don’t bother responding. It makes you look like a fool.

The health benefit to formula feeding is that the baby doesn’t dehydrate or starve. This is also a benefit that breastfeeding has – IF the mom has good supply of high-quality milk uncontaminated with anything dangerous to baby, wants to breastfeed, has the time and ability to, and suffers no ill mental or physical effects, and if the baby latches well and is happy to nurse. If one or more of those are not the case, in the developed world, formula always works.

nikkilee

Human milk is always best for baby. If it isn’t available, then formula is the next best thing. Here’s a list of what is on the label:

ALSO: Genetically engineered Soy and Corn, MSG, Phytoestrogens, Aluminum, Silicon (THESE INGREDIENTS DON’T HAVE TO BE ON THE LABEL.)

Juana

So this all-caps is to supposed to prove what? Formula contains big scary words? I would rather be scared if breast milk did NOT contain potassium, ascorbic acid or folic acid (just some examples) – that would definitely NOT be best for the baby.

maidmarian555

You know, I have a can of formula in the kitchen and the ingredients are a bit different to those you’ve listed. Idk what your labelling laws are like in the States but here, it would be illegal to list ‘bovine or soy protein’ as an ingredient as soy in particular is a potential allergen. They have to list what actually appears in the product so it would appear that you’re making things up again. Top of the list on mine is lactose. Which is indeed a sugar (I’m guessing that you’ve put ‘sugar’ as that sounds worse). It’s also fortified with a vast number of vitamins and minerals….

Nick Sanders

Here in the US, ingredients lists must as specifically as possible list all the ingredients in descending order, although I’m not sure if it’s by weight or volume. There are a few exceptions and loopholes, but the ones I know of shouldn’t come up with formula (protecting recipes by grouping non-allergenic seasonings together as “spices” or “natural and artificial flavors”, potentially variable oil blends listed with all the possible oils grouped with “and/or”; using obscured names for sugar such as “pear juice extract” to hide just how much they sweetened the supposedly healthy “juice” or “fruit chew”).

Also, somewhere near the ingredient information, and sometimes also on the front of the package, there’s an allergen warning in bold, listing ingredients such as milk, wheat, nuts, and soy that many people are seriously allergic to, plus other allergens that could be present in trace amounts due to being processed in the same facility or on the same equipment.

maidmarian555

Yeah, I suspected (particularly with infant formula) that the rules would be pretty much the same as they are here. The list she’s posted can’t possibly be an actual list of ingredients on an actual can of formula, it’s a Frankenstein’s monster created to make it look a lot more scary than it actually is. When you look at the actual ingredients, if you take out all of the scary-sounding vitamins and minerals (which I’m sure everyone would agree if pressed are actually a really good thing) then you’re left with a pretty basic combination of protein, fat and carbohydrate (of which basically 100% is sugar). But that doesn’t sound as terrifying as the nonsense she’s posted. In addition, on an actual can of formula, the nutritional information is printed right next to that list. When held up next to a really long list of vitamins and minerals, it makes a lot more sense (even if you’re not particularly literate when it comes to all those long sciencey-sounding words). One other difference I found on mine was the ‘corn syrup solids’ which are listed further down my list as ‘maltodextrin’. But that’s just a bit of added sugar. It’s not scary and it certainly isn’t the primary ingredient. Babies need sugar, their dietary needs are not the same as that of an adult (which is also where people like Nikki Lee are trying to scare parents because they may not really understand that).

Wait until you see the scare tactics about M. Alpina oil and C. Cohnii oil!

Fubgus and algae are used to produce long chain fatty acids which are good for infant brain development. But it’s not “natural” so it must be evil.

Empress of the Iguana People

And yet, so many of them use supplements. Talk about not seeing the forest for the trees

maidmarian555

Given that the “breastfeeding no-matter the cost, all natural crunchy, we-hate-formula, anti-vax” crowd are the same people who were merrily feeding their precious babies teething tablets laced with belladonna, I can say with some confidence that I’m sure the only ingredients lists they actually do read are the entirely invented ones they find online for formula and vaccines.

Empress of the Iguana People

lol, i’m sure you’re right. I was feeling nerdy enough to look at the box this morning

Dr Kitty

Oh noes! Not ferrous sulfate and tocopherols!!!
Oh wait, that is iron and vitamin E.

Pretty much everything from potassium citrate onwards in that list is either a vitamin or an essential mineral.

It’s also a bit much to be complaining about phyto-oestrogen in formula when breastmilk contains oestrogen and progesterone…

maidmarian555

It’s the same as listing “BOVINE PROTEIN and SUGAR”. Or, as it’s actually labelled on the can, whey and lactose. So milk. That would be milk. Shocking.

Nick Sanders

Taurine? Isn’t that the stuff in Red Bull?! Why are we giving babies energy drinks?

Nick Sanders

Apart from the genetic engineering, which isn’t an ingredient, I don’t believe you that something doesn’t have to be on the label. Evidence, please.

Heidi

And actually now canisters of formula do say they have genetically engineered ingredients. I still buy it! I also feed my child and husband other foods that naturally contain phytoestrogens (like soy, oats, and flax) – gasp! They have yet to grow boobs.

maidmarian555

Of course, if it’s your thing, you can now buy GMO-free organic formula like this:

This obviously creates a problem for lactivists who have long used the GMO argument as a reason not to feed babies formula. So now they’ve started saying that there are ‘hidden’ dangerous ingredients that aren’t listed on the can. Which would be yet another lie designed to frighten mothers into breastfeeding, even if it’s not right for them.

The Bofa on the Sofa

I challenge your assertion above that breast milk, if available, is always best.

I described our situation above. We had breast milk available, but it meant a stir crazy mom and it cost $15k in income. Alternatively, we could combo feed.

Which was better? Breast milk and stir crazy? Or formula and $15k?

I’ll say it again: all else equal, Breast is best. But all else is never equal.

Heidi

You are barking up the wrong tree with your FUD. Corn syrup solids are in formulations where lactose is not desirable; otherwise the sugar source is lactose, just like human milk. Phytoestrogens is not an ingredient. You think low levels of hormones aren’t found in human milk. Just because human milk doesn’t come with an ingredient list doesn’t mean these aren’t in human milk! We have a source of sugar, fat and protein. Then we have vitamins and minerals – oh the humanity! We have all given you the rundown on MSG. The human body processes for what it is – glumatic acid. Any other ideas you have about it are unfounded.

Heidi

I just let one huge lie of yours get by me. Human milk is not always best for baby! Human milk can kill a baby! Yes, kill! It’s called galactosemia. I thought you have been an L&D nurse? I’m questioning if that’s true because babies are tested for it at birth because it’s that serious.

Empress of the Iguana People

oh no, not ascorbic acid! And a bunch of other vitamins and minerals in their scientific names

Nick Sanders

VITAMIN D! Oh noes!!1!

Box of Salt

nikkilee “this is the ingredient list”

The horrors! You never passed the biology and chemistry prerequisites for nursing, did you? Or didn’t they have them when you enrolled or nursing school?

If you had even a passing acquaintance with biochemistry, you’d know that everything including & after “potassium citrate” is either an essential electrolyte/mineral, essential amino acid, vitamin, or natural component of normal metabolism.

There is no ‘soy’ or ‘corn’ in this product – corn syrup solids and soy protein are highly processed, pure substances that contain no DNA, or, for that matter, any other cellular constituent other than polysaccharides and protein, respectively.

Phytoestrogens could, conceivably, be carried over in the Coconut and Safflower Oils in trace amounts. But they would be in breast milk anyway, even from a mother who ate ‘organic.’ But there;s no evidence that they have any effects outside of the petri dish, and even then at high doses.

Aluminium: no. Just no. Aluminium is not soluble in water at all. Same with Silicon. Silicates, ie Silicon Tetroxide, sure – it’s called sand and yes probably there is a tiny amount in formula. But less than if you breastfed your child at the beach.

MSG would have to be on the label, unless the alternative ‘yeast protein hydrolysate’ is used, in which case it would be on the label instead. Phytoestrogens have been purified in the lab but are not a food additive, so of course they wouldn’t be on the label. It’s called formula because it’s FORMULATED.

And the word “baby” takes either the indirect, direct, or possessive article in Standard Written English, at least among adults. I have my doubts about you.

nikkilee

The information I posted comes from the annual Global Report on Infant Feeding and Formula; an industry publication. This is what they say is in their product.

Nick Sanders

Health benefit: baby doesn’t starve.

Who?

Does not starving to death count as a benefit?

Does suiting parents better count as a benefit?

Does providing meddling strangers with an opportunity for personal growth by allowing them to choose to mind their own business count as a benefit?

nikkilee

Does everyone do their best?

Dr Kitty

Nikkilee, once again, let’s talk about specifics, shall we?

Mum had a still birth at 39w. The next pregnancy is completely textbook but she and her OB decide to deliver at 38w, because she can’t face being pregnant any longer and her OB figures there is already evidence that her placenta craps out early. This pregnancy is textbook and foetus is healthy.

Mum has an anxiety disorder, with a previously very traumatic delivery.From 30 weeks onward she is having daily panic attacks that there is something wrong with the baby. Twice weekly BPP fail to reassure her that all is well and she continues to present at the doctors’ office in a daily basis in severe distress. A decision is made for elective CS at 37 weeks. Again- textbook pregnancy, healthy baby.

Mum delivered an anencephalic baby same time last year. It is very important to her that this baby not share the same birthday, she can’t face the idea of being in labour again on the anniversary. The birthday is 39w3d, so she and her OB decide to induce at 38w3d. Again- this is a perfectly healthy woman, perfectly healthy baby

All real cases I have been involved in.

How do you feel about the decisions thee women made in consultation with their doctors?

I’m not asking for evidence, papers or citations about risks of late prematurity. I’m asking about your gut feeling as to whether the decision to deliver before 39w were the right choices to make for these specific women.

fiftyfifty1

“The public can think that labor is like a light switch, that can be turned off and on at will”

I know not a single person of “the public” who believes this. If it were true, no baby would ever be born premature and labor would be easily and reliably started each time. Women know better.

nikkilee

I’ve heard physicians tell mothers, “Oh, you’ve been pregnant long enough. Let’s bring you in next Monday and get you induced.” They make it sound so casual, and so easy. They never tell the mothers of the potential risks. When something complicated occurs, as the result of interfering, there is an emotional and physical impact on the mother. She goes home and has to heal and take on the role of mother; the physician continues on, with no change in her life.

maidmarian555

I am bloody glad my pregnancy was ‘interfered’ with. I got to go home afterwards with my son. I get to cuddle him and tuck him into bed every night. I would not have been able to ‘heal and take on the role of mother’ without that interference. And I was warned in advance that the process would take at least 24-48hrs. Nobody suggested it was some sort of instant magic.

Amazed

Because, of course, you’ve been inside the doctor’s office for every visit and know what’s been discussed.

I’d say the potential death due to postmaturity will certainly take emotional and physical toll but well, you deny that there are risks.

Butting yourself into the conversation of perfect strangers with unsolicited advice is the peak of self-entitlement. What was this about nikkilee believing in individualized care? Or do you think it like, “Only I can offer the individualized care that will help only you to become a mother?” All hail nikkilee the savior of babykind and motherkind!

fiftyfifty1

Inductions, especially in nullips, are never guaranteed to be easy or fast. But inductions at term improve outcomes for both mother and baby- they reduce CS. Do you tell women the fact that getting an induction gives them a *higher* chance of successfully delivering vaginally than waiting for labor to start naturally? If doctors “make it sound so casual” it’s not because they are nonchalant. It’s that why should there be hand-wringing when the evidence is clear?

It gives a pretty comprehensive guide as to why you may need to be induced, what the procedure is like, how long it may take and what the risks are (including percentages of women in this country who were induced and then ended up needing a caesarean). Nobody is hiding anything. This information is freely given to pregnant women so they can make decisions that are right for them and know what the risks might be.

Azuran

Generally, it’s not something that comes out of nowhere. Maybe YOU feel it came out of nowhere because you weren’t part of the whole conversation and the whole pregnancy.
But my due date was calculated on my very first appointment. I’ve been given information on dates and what to expect pretty early on. What to do if my labour started, and how they would proceed if labour is delayed after 40 weeks. I’ve also seen many of my friends go through he same thing, and no, they don’t go ‘well, 40 weeks, you’ve been pregnant long enough’ They monitor, give it a few day, recommend soft things like exercice and stuff, then they schedule a stripping and give it another few days. Generally, the proper induction is scheduled between 41-42 weeks, and the woman knows about it, she has been informed long in advance and knows the date long in advance.

So you, you might only hear ‘you’ve been pregnant long enough’. But that was the conclusion of a conversation the woman has been having with her doctor for weeks.

nikkilee

This is not the case for other mothers. Due dates are often revised, and are at best, estimates.

Dr Kitty

First trimester ultrasounds are accurate to within a few days.
NO ONE should be having due dates changed on the basis of second or third trimester measurements.

If further along the baby is measuring small or big for dates, it is a growth issue, not a gestational one.

Do you not know this?

nikkilee

ACOG says this, ” .. When determined from the methods outlined in this document for estimating the due date, gestational age at delivery represents the best obstetric estimate for the purpose of clinical care and should be recorded on the birth certificate.” In the US, the date is identified as the EDC, and is an estimation. In my 2nd pregnancy, I had 3 different confirmations of the due date: LMP, ultrasound (for the CVS) and my BTT chart. She came at 43 +3, covered in vernix. I will always wonder if there is some genetic influence from the paternal side; my husband’s mother went a month past her due date with all 4 children, all born healthy at home. My first child (different father), came the day before the EDC.

Azuran

Where are you even going with this? The ACOG clearly states that first trimester ultrasound is the best way to determine gestationnal age at birth that at this date is what should be used to determine the gestational age at birth.
So your baby had vernix, doesn’t mean it wasn’t 43+3, post term babies can still have it. (but then again, you look like you had your kids a few decades ago, so perhaps gestational age estimation wasn’t what is it today back then, have you thought about this?.)
Same with your husbands mother, she obviously had her kids quite a few decades ago. Prenatal care has evolved a lot since then.

nikkilee

Did you read the whole post above? I had 3 different confirmations of the EDC. ACOG says the technology gives the best estimate.

Azuran

They don’t say ‘the technology’
They say: First trimester US is the most accurate to ‘determine or confirm’
They do say, for example, that other measures should be used in case of IVF.
Basically, in a normal pregnancy, they use the early ultrasound to either get a date when there is no other way, or to confirm a date, such as when you know your LMP, because sometime you could still have had some bleeding that you mistook for a MP.

But beyond that, they don’t ‘revise’ or ‘change the due date. If later testing show variation, they stick with the early date because it is the most accurate. And they are accurate within a few days. Seeing as a baby can naturally be born basically anywhere between 37 and 42 weeks, those few days of error are practically insignificant.

Dr Kitty

Your only reason to doubt the accuracy of your dates is that your baby didn’t look like a typical postdates baby because she had vernix.

The idea you’re promoting that some babies (like yours, presumably) need longer to cook than average, and therefore that the risks of post maturity magically don’t apply to them because they’re ” not ready to be born yet”is NONSENSE.

nikkilee

I had 3 confirmations of my date. The evidence says that there is a range for human gestation.

Azuran

But really, what’s your point?
You know, when arguing about something, one should have a point. You shouldn’t be arguing just for the point of arguing.
So, what is the point you are trying to make?
Yea sure, Due date are estimations, that’s not a secret. They are, however, still very accurate estimation. But why are you arguing against them? What is your argument?

Are you saying we should stop dating pregnancies because it’s not 100% accurate 100% of the time?
That induction shouldn’t be recommended for post date women in case that she is the what 1/god knows how many women who might have a slightly less accurate due date and ‘maybe’ she’s at 41 weeks instead of 42?
Do you even have ANY kind of data to support that babies are routinely harmed because of an inaccurate EDD?
And do you have another solution?
Do you have a more precise method of dating pregnancy? One That could be used as widely as early ultrasound and LMP?

What is the point that you are trying to make by complaining about EDD?

It is not treated as a certainty, it is treated as the most valid date we have, and it is accurate down to a few days. No one is acting like your due date is a golden magical real date that you are supposed to give birth at. It’s just your 40 weeks date. Everyone, everywhere, knows that normal birth can happen between basically 37-42 weeks.
Again, what alternative option are you offering?

Heidi

Populations, not individuals! Isn’t that what you’ve been saying the whole time?

Dr Kitty

Also, forgot to mention, if women are planning pregnancies and are taking using OPKs, charting temps and taking HPTs from day 7 post ovulation, of have IVF pregnancies it’s REALLY hard to move the goal posts sometime in the third trimester and say the baby is due a week later, given that dates of conception and implantation are pretty much certain.

You have to know this.

The only time in my recent memory when the first scan dates didn’t match within a few days of LMP was when the woman had PCOS and hadn’t menstruated for almost six months. In that case the “first scan” was done by the gynaecologist investigating her amenorrhoea, and the finding of an 11 week foetus was a shock to all parties!

Azuran

It was the case for every single mother I know. Every one gets a date scan if they don’t know their last period. No one had their due date change.
And you have shown, from your own blog, that you are not over getting your nose into other people’s medical decision without even having all the information.

fiftyfifty1

Yep, in that link, nikkilee overhears a conversation where a soon-to-be grandmother is telling a friend that her daughter is going to be induced the day after Christmas. Apparently the OB had wanted to induce on Christmas Eve, but the mother-to-be had “talked her doctor into waiting”. At that point nikkilee butts in uninvited and tells her that induction “isn’t good for the baby”, and “that induction of labor was one reason that babies went to intensive care” and “How happy will this mother be if her baby is in the NICU?” She then insinuates, without ANY individualized knowledge of the patient’s risk factors, that the doctor is doing the induction for convenience because “the doctor was willing to negotiate the date.” She tells them “Babies know when they are ready to be born”. The woman then tries to bring up concerns about the hard-won nature of this pregnancy and the risk of losing the baby..“well, but this mother needed help to get pregnant.” But nikkilee is having none of their concerns. She oh-so-glibly shuts them down: “Think about it” I replied, and walked away.”

Quacks like nikkilee love to spread lies and fears and doubts. Not only does it stroke her ego, it’s the source of her revenue.

Amazed

The only responsibility nikkilee takes is to her own living. Good nice old sums. Individualized care? Ha!

Azuran

except that they shouldn’t be two vastly different things.
The risks/benefits of formula vs breastmilk are exactly the same when you are discussing it here and when you are suggesting things to your client.
So if what you are saying isn’t the same, it means that you are lying to one of the group. So, are you lying to us? Or are you lying to the mothers?

nikkilee

If a postpartum mother, after discharge home, can’t/won’t breastfeed, there is no point in any discussion about it. Her concerns are different. Timing is a big part of education.

Azuran

And if a woman in the hospital can’t or doesn’t want to breastfeed, then there is no point discussing it further either. She made her point.
And if it’S 100% acceptable for a woman outside the hospital to not want to breastfeed, it is equally acceptable for a woman in the hospital.
If you are telling the mother at home that it’s fine if she doesn’t breastfeed because it doesn’t matter that much, the woman in the hospital should be told the exact same thing.
Because the truth about breastfeeding benefits doesn’t change.

nikkilee

Half the mothers using bottles of formula in the hospital were doing that for sincere, yet incorrect reasons. As with the mother not wanting her baby to be exposed to any analgesics she was taking after cesarean section. Or the mother, whose first baby died of SIDS, who was angry that no one had mentioned to her that breastfeeding reduces SIDS risk. IT is always a conversation worth having. . . once.

Did you caution the woman that losing one baby to SIDS means there’s potentially an increased risk for the current one? Did you give her complete information on reducing that risk, including bedding/cosleeping issues? Was she equally as angry that nobody had mentioned pacifier use being as good as breastfeeding, to give her more options?

Dr Kitty

If the woman agrees to it, and the time to ask for her consent is not when she is sleep deprived, in pain and in the midst of the immediate postpartum hormonal maelstrom.

Azuran

No one here is claiming that epidurals are a risks for breastfeeding. So I don’t see why you bring that up. If anything, she probably got that idea from the NCB movement, who keep telling that epidurals are dangerous. (after all, if you claim that the chemicals of the epidural ends up making it’s way through the placenta, it’s only logical that it also goes into breastmilk.)
No one is saying we shouldn’t talk about SIDS either. We are saying that it shouldn’t be overblown and that other means of preventing it should be properly discussed (such as the risk of bedsharing, or the benefits of a pacifier)
So tell me, when you advice people on the benefits of breastfeeding to reduce SIDS, do you also tell people of the risks of bedsharing and the benefits of pacifiers?

So really, you are just arguing stuff that no one is arguing about.

momofone

So I trust you took that opportunity to tell her about the protective effect of pacifier use?

Dr Kitty

Nikkilee- I had every intention of BF my second kid, and I did, but I found the NHS antenatal “breastfeeding advice” the midwives were required to give so patronising, infantilising and unhelpful the first time that I scored a big line through the “breastfeeding and skin to skin advice checklist” in my notes the second time around and wrote “Do NOT wish to discuss” on it. So they didn’t.

Sometimes it’s not the timing or the maternal concerns that are the issue, it’s the content of the “education” being offered.

Roadstergal

Given that the PROBIT and discordant sibling studies found no effect on obesity (despite the remaining confounders) and that my generation has _far less_ obesity than the current generation, despite having almost no breast milk, I’m calling bullshit on formula feeding having any effect on obesity, and breastfeeding having any protective effect at all.

The Bofa on the Sofa

That is a decision left up to the woman and her provider.

But you don’t actually believe that. You have made it clear that you only approve of induction for “true” medical indications. And you don’t approve of inductions based on factors you don’t agree with, which include “convenience” of having the doctor and patient available at the right time. That is a decision made between the woman and her provider, and you don’t approve.

So don’t give us this crap about it being a decision left up to the woman and her provider.

Dr Kitty

Exactly.
If it were a decision best left up to the individual woman and her provider Nikkilee wouldn’t be bemoaning inductions and CS done for “convenience” and trying to reduce them.

39w, BTW is the LONGEST women over 40, diabetics, women with he of IUGR and women with very high BMI are recommended to stay pregnant.

Those demographics are growing, therefore the rates of inductions are going to increase.

The rates of late still births and associated morbidity (meconium aspiration, shoulder dystocia, foetal distress during labour from placental insufficiency etc) are increasing where the 39w rule is being adhered to strictly.

fiftyfifty1

So nikkilee thinks that the placenta detaching is a “true medical reason” for induction. No honey. A placenta detaching means the induction should have happened a week ago. When the placenta is detaching you have one option: a crash CS. And even then it’s often too late.

Correct me if I’m wrong, but don’t they, in every other wing of the hospital, try to prevent infection? NIkkilee thinks that the maternity ward should be the exception, and a woman with broken membranes should just wait around for infection to happen, and only then get the ball rolling on induction?

fiftyfifty1

Exactly. For her to endorse induction it has to be already in the realm of emergency.

Erin

Speaking as someone whose son was born 81 hours after their waters broke, I can categorically say, if I knew then what I know now, I would have been “politely” asking those midwives to get me a Doctor at hour 1 to discuss options rather than trusting their “your body knows what it’s doing”. I would much have preferred a semi elective section rather than an emergency in which I lost my mind and my baby ended up in NICU. I mean the “benefits” of breastfeeding pretty much takes a back seat when you think your baby is a doll.

In fact since said waters broke at almost midnight on Friday the 13th, I’d have been better off phoning an exorcist en route to the hospital than trusting the midwives.

There are partial abruptions; a complete abruption leads to the emergency cesarean section.

Here’s what the Mayo Clinic says: “If you have mild placenta abruptio and your baby is not in distress, you may not have to stay in the hospital.

You and your baby will be checked often throughout the rest of your pregnancy.
If you are in preterm labor and are far from your due date, you may be given medicine to stop labor.”

fiftyfifty1

See, this is so typical. You pull quotes that you think support your position without understanding what they mean.

Yes, a pregnancy can have a small abruption remote from term that stops on its own. If that’s the case, you might as well go home. It’s either going to stay attached, or it’s going to resume detaching (and fetus will die) but there is nothing you can do about it. This is a world of difference from a near term baby with a placenta that is currently, in your own words, “tearing away”.

nikkilee

That’s exactly what I said.

fiftyfifty1

No, you said that if a baby’s placenta is detaching, that that is an indication to start and induction.

Roadstergal

Wait – so you’re saying in that instance, of an early-pregnancy partial abruption – that’s when you would recommend an induction??

Who?

What would being forced look like? Note that being informed by medical professionals about the risk of refusing to be induced is not ‘force’.

nikkilee

As is being informed about the risks of induction.

maidmarian555

I can tell you that nobody warned me about the risks of *not* having an induction. I was simply told it was *not allowed* before 40+11 at the absolute earliest.

Roadstergal

What risks of induction, nikkilee? You love fact-free assertions, don’t you. I linked you to a meta-analysis showing some of the benefits of term induction. Show me any data (an actual paper, please, FFS) on the risks of induction vs expectant management.

Do you have a problem with reading comprehension? This isn’t a rhetorical question. I asked specifically about induction vs expectant management, as that’s the conversation on the table. A woman gets to term and she doesn’t go into labor. When should she induce?

The two papers you gave me don’t address that question at all (although the second noted the research showing that induction can reduce C-section risk). The Mayo clinic page is obviously not up-to-date, since they start off by saying that induction increases the risk of C-sections, which you agreed above is not accurate.

The Bofa on the Sofa

Why are doctors intervening before 39 weeks?

Because there is some other problem, of course.

Why shouldn’t we intervene when problems present?

maidmarian555

I don’t know about you, but I’d rather have a planned operation done by staff during the week when there’s more staff/cover about and they’re not all exhausted rather than say at 5am on a Saturday morning when they’re at the end of a rough shift and knackered.

MaineJen

Weirdly enough, both of my kids were born on Saturday nights…didn’t need CSs, though 🙂

maidmarian555

My son was born via CS at 5.56am on a Sunday morning. Did they do a great job? Yes. Was I pleased I got the OB who performed the operation that I did? Yes, she was lovely. Would I have preferred if I’d had the choice to have said operation on a weekday with staff who were not at the end of a long Saturday night shift? Yes. 100%.

MaineJen

As I would have preferred to NOT have my water break at bedtime on a Friday night, after a long and exhausting week at work. Almost like you can’t “plan” these things at all, isn’t it? 😉

maidmarian555

Next time (assuming there is one) I am TOTALLY pushing for a planned CS with a date and time. *Everything* will be done for convenience (both mine and that of the medical staff). Hooray!! (Of course I am assuming that #2 would be less determined to crush all plans I make ever like #1 does but I can hope, right?!)

moto_librarian

But what is the PRIMARY rate of c-section? That number is for ALL sections, including repeats.

Heidi

If you actually believe many physicians are pushing C-sections for convenience, then why are you not advocating for a different model for the doctors? I went with an OB/GYN practice where all the doctors were my doctor. Every 12 hour shift at the hospital was covered by one of my doctors. They were always going to be relieved so there was no pressure to push interventions for the sake of “convenience.” I don’t want a doctor that’s worked much longer than that anyway. If I had to choose between getting a planned C-section by a well-rested doctor or if I had been laboring for over 16 hours and my doctor was there the whole time, I’d choose the well rested doctor and c-section! I’ve seen you lament overworked nurses, and I’ve worked in healthcare, I surely am not disagreeing that nurses and others are being overworked and understaffed, but so are the doctors. It’s almost like you have an anti-doctor agenda when it comes to childbirth.

momofone

I’m a huge fan of c-sections for convenience. In fact, I’m a huge fan of convenience in general, whether that’s method of delivery, or feeding, or any of the other million things parents have to decide.

Sarah

Inspired by nikkilee’s post, I now feel sections should be as inconvenient as possible. They should only be performed on people who aren’t even pregnant.

Heidi

I don’t know that anyone has denied that stress can cause lactation issues. That was not what you originally said. We were talking about c-sections causing lactation delay. Maybe the events surrounding the need for the c section stressed mom out and affected her lactation but proving that the actual c section caused it seems pretty hard to prove.

Amazed

So many things can cause lactation issues or not cause them that I wonder how many of the happy endings with a mom who felf support from nikkilee or another consultant of her type were just “meant to breastfeed” anyway.

My own mom comes to mind. After nearly dying from a PPH she came home with a huge hungry baby, zero engorgment and not a drop of colostrum, let alone milk. She was frantic with worry because at this time, the only way to get formula was to have thick connections in the right places (Eastern Europe in the 1980s wasn’t exactly the best-appointed part of the world except for those related to the regime.) and she didn’t have them. The hospital dropped the ball and told her to find formula. Find formula from where? There wasn’t any! I remember him turning blue with wailing as my father mixed powdered milk, he was so hungry. I was fascinated how he changed colour. My parents were less thrilled, I suspect. They were damned scared, and not because of diabetes, IQ points, obesity or whatever is the vogue those days. When I woke up the next morning, he was already at the breast, draining it in a hurry. My mom’s milk had just come in, 10 days after the traumatic birth, and with no signs in advance. If she, in her fear, had consulted a LC after the doctors basically told her that there was no chance for her to breastfeed, she would have sang the LC praises when the reality is, her milk just came in, as simple as this.

I suspect mother communities might give LC false credit sometimes.

Roadstergal

I think that’s a very key point. I know some folk here have talked about the timing of milk coming in and the lack of any evidence that the LC stuff – pumping, nursing, rinse, repeat – results in milk coming in any sooner than resting while the baby gets some formula.
Lactivists will never support a trial to compare the two, because I think somewhere, deep down, they know that the latter will work just as well, if not better. :p

Heidi

I’ve never seen them support studies to investigate what in breast milk might cause these supposed benefits either. I really don’t think breastfeeding is ever going to take off because it’s hard, time consuming, and doesn’t even work sometimes. You can’t support someone into enjoying or even finding it remotely tolerable having a baby attached (around the clock) to their boob if they don’t enjoy it hence the lactivist tactics of shaming and guilt-tripping. Surely you’d think they’d want thorough studies to find out by what mechanisms breast cancer prevents cancer, SIDS, colds, diarrhea, pneumonia, PPD, all the claims they make? If we found out what it was, well, we could fortify formula with it! Problem solved, right? More feasible than trying to make everyone breastfeed.

I thought this was known to be due to the suppression (or expression?) of estrogen that occurs while breastfeeding? That’s why it is cumulative?

It’s the same type of benefit you’d get from the Pill.

Someone can correct me if I’m wrong.

Heidi

For ovarian cancer, I do believe? The less you ovulate, the less your chance, I think. Reading the study that actually went with that fact-free press release Nikki Lee posted, there may be some small benefit to reducing the risk of breast cancers (~10% reduction) that aren’t hormone sensitive (20% of breast cancer cases, more prevalent in African Americans) although if I’m understanding correctly, they don’t know why that would be. Having children and having them at a younger age also reduces the chance in and of itself even if one doesn’t breastfeed. Breastfeeding appears to have no benefit for the other kinds of breast cancer, although the authors of the study weren’t willing to really accept that and declare more studies need to be done because surely it does! I wonder if Nikki Lee is shouting from rooftops that women need to pop out some babies as teens to reduce their cancer risk?

Chi

Of course the reason for the ‘art’ of delivering breech babies declining has absolutely NOTHING to do with the fact that doctors recognize how dangerous such a delivery can be (for both baby and mother) and have developed a much safer alternative?

/sarcasm.

nikkilee

As with any procedure, there is an art that goes along with the science. In the right hands, as with the OB/GYN with whom I worked in the late 80s, 2 of types of breech can be delivered safely. Nowadays, in this country, a cesarean section is safer because the OB/GYNs don’t know how to deliver a breech.

Roadstergal

Define ‘safely,’ nikkilee. Death rate of the baby for breech vaginal birth vs C-section. Give me numbers. Because death of the baby is sort of a big deal to moms for whom a live baby is the reason they got pregnant, not the chance to brag about a vaginal birth and breastfeeding.

The Bofa on the Sofa

Oh, I suspect that nikilee will concede that overall, C-sections are safer than breech. But see, that’s just because doctor’s these days aren’t any good at vaginal breech. There are some that are, but most aren’t. The bad outcomes are due to those who aren’t skilled. The ones who are skilled have just fine outcomes. If you ignore the bad outcomes, then breech delivery is just fine.

How do we know who aren’t skilled? Because they have bade outcomes. And how do we know who are skilled? Because they haven’t had any bad outcomes. Yet.

Chi

Did you miss the part about breeches being fucking dangerous???

They have ALWAYS been dangerous, they haven’t become dangerous because OB/GYNs have ‘forgotten’ how to do them.

Who?

One of my very first posts here-a couple of years ago-was asking the question about whether it was a bad thing that these skills had apparently been ‘lost’.

One of the doctor posters-maybe candoc or fiftyfiftyone-trenchantly pointed out that ‘practicing’ on actual people was not the best idea, and that losing skills that were now, effectively, outdated, was unconscionable.

We know more, we do better. It’s not like a breech baby is starting out with the best hand of cards-wishing breech was safe or that a ‘normal’ (hate that word) delivery is a fair choice in all the circumstances doesn’t make it so. Something the nickilees of the world just don’t get.

Who?

My bad-

‘…using skills that…’

moto_librarian

It’s safer to deliver breeches via c-section because of advances in diagnostics, anesthesia, and surgical techniques. I doubt that it was “safer” to deliver breeches vaginally even in the late 1980s. The reason OBs don’t know how to do them is because they have a better, safer option than rolling the dice and hoping that the baby’s head doesn’t get stuck.

momofone

OBs aside, many women don’t have any interest in vaginally delivering a breech (I’m one of them, and just for full disclosure, I have no interest in vaginal delivery for any reason) BECAUSE c-sections are safer for the babies. I was breech. My mother had a hell of a time delivering me (she was not able to have pain relief) and recovering. The extent of the damage caused by my birth caused the OB to tell her I would be an only child, because he did not expect she would ever be able to get pregnant again. C-section would have made her life immensely better both short-term and long-term, given the difficulty the damage caused as she aged. I personally wouldn’t care whether an OB knew how to deliver a breech or not; I would care whether s/he knew how to do the c-section I would request and expect.

Roadstergal

Why should I do a google search? Why don’t I instead show you the research demonstrating that induction _reduces_ C-sections compared to expectant management? Here you go, here’s a meta-analysis:

“Overall, the risk of cesarean delivery was 12% lower with labour induction than with expectant management (pooled relative risk [RR] 0.88, 95% confidence interval [CI] 0.84–0.93; I2 = 0%). The effect was significant in term and post-term gestations but not in preterm gestations. Meta-regression analysis showed that initial cervical score, indication for induction and method of induction did not alter the main result. There was a reduced risk of fetal death (RR 0.50, 95% CI 0.25–0.99; I2 = 0%) and admission to a neonatal intensive care unit (RR 0.86, 95% CI 0.79–0.94), and no impact on maternal death (RR 1.00, 95% CI 0.10–9.57; I2 = 0%) with labour induction.”

‘Pre-term’ was defined as before 37 weeks, so the 39-week no-induction rule is surely causing some C-sections that could be avoided.

And the effect is substantial even in your pretty textbook low-risk pregnancies:
“In uncomplicated term pregnancies with no medical reason for induction provided, the risk of cesarean delivery was reduced by 19% on average.”

And yes, I’m sure stress does affect milk production. Generally speaking, non-necessary biological functions (and as far as mom is concerned, making milk isn’t necessary to her own survival) are subject to stress, which is why some women skip periods under stress. So why don’t lactivists promote stress reduction for women with newborns? Adequate pain relief, a well-baby nursery and supplementation so mom can rest? Why do lactivists _oppose_ stress reduction for women with newborns?

nikkilee

Better to have paid maternity leave, and home visitors often, as is done in other countries.

Roadstergal

So no discussion of anything substantive in my post? Is that a consequence of VPDs, or a side effect of all of those supplements you have to take?

So, are you going to admit that you were wrong about your opinion of pit, stop talking about ‘pit to c-section’ or how doctors are using pitocin to force women into having c-section for their convenience?

Box of Salt

nikkilee “Better to have paid maternity leave. . . ”

Duh.

But I am glad you have come around to my point of view on that point.

Sarah

Why is it either/or? You can have well baby nurseries and home visits often after discharge. We used to have that in the UK: alas no longer.

Karen in SC

yeah but we don’t and probably won’t ever have that.

Box of Salt

nikkilee “I worked in L&D for years” When was that? Back in the late 1980s (as you mentioned in other comments on this thread), when we had new mothers discharged within 24 hour after delivery per insurance coverage? Those experiences are irrelevant to what’s going on in today’s L&D wards. I’m not sure that my own experiences (a decade ago) are relevant any more, either.

“cesarean sections are done for convenience too” Why, yes, it was much more convenient to schedule my second cesarean at 1pm instead of having to go through another round of TOL whenever it started, and end up a c-section anyway.

Oh, and how did their c-section births (one after TOL=FTP, one scheduled) affect their ability to nurse, and/or the duration? Why don’t you tell me what you think happened.

No, seriously, nikkilee, either hypothesize, or pull things together from my comments. I’ll do my best to keep track of reply in spite of refusing to use Disqus.

nikkilee

I can’t speculate about any one particular situation. Mothers in my region are routinely sent home 36-48 hours after a vaginal delivery; in addition to a technologically driven birth (the norm here), the mothers are overwhelmed with too much information (SIDS prevention, shaken baby, vaccines, hearing test, medicalized breastfeeding support and more) , and are interrupted every hour as nurses are required to go into a mother’s room every hour. So getting sleep is even more difficult. The majority of maternity nurses that I teach tell me about this; about how nurses are working at least 1.5 FTE each, because staffing is rarely sufficient. Day shift nurses are supposed to take care of no more than 3 dyads (AWHONN and AAP recommendation) and are more likely to be responsible for 4 or 5: that’s 8-10 people in one shift. Too many. In my career pitocin has gone from being a drug that was used sporadically to a routine practice where the only mothers who don’t get pitocin in labor are the ones who deliver in triage or in the ER. There is little evidence supporting many routine obstetrical practices.

Azuran

Too much information? You think we shouldn’t be talking about SIDS or shaken baby syndrome? wtf is wrong with you? Oh let’s not make sure your baby can hear, hearing it’s not important. Info on breastfeeding support? Nah, who needs that.

Heidi

I’m not sure how she plans to reconcile a better nurse to patient ratio but also increase a patient’s stay. Seems to me that would only worsen the nurse-patient ratio.

Heidi_storage

Yeah, well, if a first time parent doesn’t know when a newborn needs medical attention, then the kid probably wasn’t meant to live, anyway.

Heidi

Why do nurses need to check on a dyad every hour? Is it perhaps because we’ve done away with nurseries? If a mom is being forced to room-in and exclusively breastfeed, the LEAST we should expect is for her to be checked on hourly to be sure she hasn’t fallen asleep while nursing and that her baby is safe. Who is pushing these “baby friendly” policies? It’s not us at Skeptical OB.

Heidi_storage

What is “medicalized breastfeeding support”?

Sarah

Come on, you love speculating when it suits you.

Box of Salt

nikkilee “I can’t speculate about any one particular situation.”

Why not? Just take a guess. I am asking you to guess. Or, look around at my comments at let me know what you think happened.

nikkilee

I can’t possibly know and don’t want to guess.

MaineJen

Well now, why would we ever want to bother their pretty little heads about SIDS, SBS, vaccines, whether their baby has hearing loss, or help with breastfeeding??? Better to just let them fend for themselves, as nature intended. I’m sure, at home, with other children running around and a family to care for, she’d get much more rest, right??

And…nurses check on you every hour to make sure you’re okay, your baby hasn’t collapsed unexpectedly, you are healing well and not hemorrhaging. They do not do this for no reason.

Are you *sure* you worked in L&D?

The Computer Ate My Nym

C-sections are done for breech delivery because a large clinical trial demonstrated that more breech babies die in vaginal deliveries than in c-sections. Why the hell would anyone NOT do a c-section after that information came out?

maidmarian555

My best friend went into labour and it transpired that her daughter was breech. Things were progressing very fast but the doctors still went through the risks/benefits for both vaginal and c-section birth and made it clear they would support her regardless of the choice she made. That was just a few months ago in the UK. I’m aware that things aren’t the same everywhere but certainly here, nobody will ‘force’ a woman to give birth to a breech baby via section and the skills for that type of delivery haven’t been ‘lost’. They will explain why that might not be a great idea, they will explain what the risks are but if you’re hell bent on taking those risks they will do whatever they can to get you both through the birth and out the other side fit and healthy. People like nikkilee that peddle these untruths surrounding hospital birth really pee me off.

Dr Kitty

Nikkilee, my CSections were done for convenience.
MY convenience, because I had no interest in rolling the dice to see if my wonky pelvis would lead to CPD or not, and once you’ve been involved in the medical care of a TOLAC with UR and a poor outcome it really puts you off VBAC.

Why was it unfortunate?
My kids are healthy and appear to be very smart (I say appear- the seven year old can do long division, it’s hard to accurately judge the 16 month old). I have no regrets and had an easy recovery both times.

Both of my kids were breastfed for over a year, because I know that is important to you.

Why are elective CS “unfortunate” if they are what the woman wants and everything goes well?

I opted out of labour, scheduled my kids’ birthdays for when it suited me best and have an intact pelvic floor as well as two wonderful kids… what was unfortunate?

It totally depends on each individual cases. You cannot decide that one option is the best option.

My cousin’s baby is footling breech. They are going to try a version, but if it’s not successful, surgical birth is MUCH safer than vaginal birth.
One of my colleague had uterine fibromas, for her, c-section was the safest option. She had the fibroma removed after the birth of her daughter, but she is at high risk of rupture if she ever gets pregnant again and vaginal birth is increadibly risky for her.
Another colleague had both placenta previa AND a transverse lie. There was literally 0% chance that she could give birth vaginally.

And each individual’s own aversion to each risks has to be taken into account. What you think is too great a risk for you might not be the same for another woman.

nikkilee

We agree that care needs to be individualized.

fiftyfifty1

“We agree that care needs to be individualized.”

Yes, but what we don’t agree on is informed consent. Nikkilee believes it is good enough to present the patient with the BENEFITS of her preferred choices (breastfeeding and vaginal birth) along with the RISKS of the opposite choices. We medical professionals, in contrast, see it as our duty to give the whole picture, with risks and benefits of both sides. We believe this is the only way to truly individualize care.

nikkilee

The best outcomes come with breastfeeding and vaginal birth; this is not always possible, in which case there are interventions that become necessary.

Nick Sanders

[citation needed]

Heidi

If those outcomes are not always possible, then they don’t always produce the best outcomes. What you meant to say actually is they produce the best outcomes from your perspective, which is heavily based on your beliefs.

nikkilee

No. To clarify: breastfeeding and vaginal birth are not always possible.

momofone

Or desired.

Sarah

Or desirable.

Amazed

With this, you turn breastfeeding and vaginal birth into a purpose and not a route. Why am I not surprised? Shifting people’s prioriries is what helps you line your pockets nicely. Of course, it’s still despicable.

And of course, you are also despicable for being an anti-vaxxer.

Roadstergal

Hm. With my friend’s C/S, she was present for the birth and went home with her baby after three days. With her VBAC, the pain was so bad she wasn’t present for the birth and only remembers it in nightmare flashbacks, and the baby was in the NICU for over a week. You should go tell the babies that they got it backwards, because they should know better than to have the better outcome with the C/S.

swbarnes2

See, here you go. Many mother/child groups will not get the best outcomes with those procedures. Someone who actually cared about individualized care would not have written what you just wrote.

fiftyfifty1

“The best outcomes come with breastfeeding and vaginal birth; this is not always possible”

I had a vaginal birth and breastfed, so in my case, both were possible. And yet the outcome could in no way be called “best”. The outcome couldn’t even be considered “good”. My baby and I would have been much better off had I had an elective CS and formula fed from day #1.

Box of Salt

“The best outcomes come with breastfeeding and vaginal birth”

Nonsense. The best outcomes go with whatever it take to have a healthy baby.

You are talking process, not outcome.

Azuran

Then why are you here arguing that breast is best and vaginal birth is best? Leave that to each women to discuss with their care provider and make their own decision.

swbarnes2

But you don’t agree on this. Every time you argue specifics, you show that you don’t. Because you refuse to admit that for many women, the best care for their individual situation is a C-section, or an epidural, or those interventions that you so loathe.

When your meaningless platitudes say one thing, and your specific arguments say something else, everyone is going to believe that the specific arguments are what you really mean, and that the platitudes are a dodge to avoid accepting the consequences of your claims.

nikkilee

Cesarean section and epidural and vacuum and forceps and IVs and pitocin all have their place when they are needed. I protest their routine use.

Box of Salt

nikkilee, where’s your evidence any any of those things are used routinely?

4) Here’s another: https://www.cdc.gov/nchs/products/databriefs/db200.htm “As the use of medical interventions for childbirth (i.e., induction of labor and cesarean delivery) has increased during the last few decades, an increasing proportion of deliveries occur during regular daytime hours”

momofone

Are all nurses required to take your classes, or do they choose–are they self-selected?

nikkilee

Hospitals that are on the BabyFriendly track require nurses to take a course. There are many options; mine is but one. Many choose my course. Hospitals bring me to them to teach staff also.

Many community workers: doulas, nutritionists, medical office staff, and staff from organizations choose to take my course.

momofone

So largely self-selected.

moto_librarian

And again, I’m going to be asking a lot of questions about just who gets to teach classes and what counts as continuing education at my hospital.

Bells

Nikkilee, are these hospitals where you teach aware that you teach bedsharing?

nikkilee

I don’t teach it.

“The safest place for an infant to sleep is on a separate sleep surface designed for infants close to the parents’ bed. However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep. It is important to note that a large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no pillows, sheets, blankets, or any other items that could obstruct infant breathing or cause overheating should be in the bed. Parents should also follow safe sleep recommendations outlined elsewhere in this statement. Because there is evidence that the risk of bed-sharing is higher with longer duration, if the parent falls asleep while feeding the infant in bed, the infant should be placed back on a separate sleep surface as soon as the parent awakens.” http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938

Roadstergal

#4 – in nikkilee’s world, it’s a bad thing that as we have more control over the timing of births, more deliveries are occurring during hours when the hospitals are best-staffed and the staff are well-rested? You’d prefer all deliveries be at 2am?

Also, I noted below the evidence that prompt term induction reduces the incidence of unwanted C-sections. You even agreed. So why are you still yammering about the evils of induction?

MaineJen

Huh…I had pitocin at some point during both of my births, and both of my kids were born on Saturday nights!

In both cases, labor was induced/augmented because my waters had been broken for a long, long time, and waiting any longer for natural labor to begin/take its course would increase the risk of infection (for birth #2 I was known GBS+). Tell me why that wasn’t necessary, nikkilee? Tell me how that was done for anyone’s “convenience?”

Sarah

That’s a news article about a study on that minority of sections performed before 39 weeks. You’re going to need to do better than that.

Here’s something to try: each of your study links has a few suggested further studies in the right hand column. Often these suggested studies are larger, better designed and newer. For instance your first link suggests a paper that is an analysis of the risks to the baby of vaginal birth such as brachial plexus injuries, intrapartum stillbirth and brain damage, and shows that these risks are reduced by ~85% with elective CS at 39 weeks. Your second linked study claims that CS is associated with an increased likelihood of autism, but the suggested follow-up study was a more recent and better designed discordant sib study from 2015 which showed that the apparent increase in autism disappears when confounding is eliminated. I could go on…

Sarah

Not offering us any analysis then?

The problem here is that much of what you link to simply mentions risks that might be associated with CS delivery. So even taking the studies offered at their highest, that’s not evidence that it’s more risky per se than VB. It’s just evidence that it has risks, which is true. All modes of birth do. In order to back up your claim that CS is more dangerous per se, you need to tell us why the risks are more significant than those associated with VB. So for example, we know that CS is more likely to lead to placenta problems, miscarriage and stillbirth in future pregnancy, which is a risk for those women who may conceive again. How does this weigh up against, say, risk of shoulder dystocia, brain damage, perineal tearing?

And this is not to say that the studies you link to are necessarily robust, relevant or say what you want them to anyway. You have one which talks about risk of ELCS before 39 weeks, not risk per se, and issues in future pregnancies which of course is only relevant if there are going to be any. You have one about autism which doesn’t from the abstract appear to have controlled for the factors that led to the section in the first place. You have one that finds no risk associated with EMCS wrt the condition being considered, and another relating to asthma which doesn’t account for genetic factors. Typical NCBer though, no understanding that factors leading a child to be at more risk of a particular condition might sometimes also make a CS more likely.

fiftyfifty1

“The risks are greater with surgical birth. ”

No, it’s much more complicated than that. Choosing a CS is almost always safer for a current fetus. On the other hand, a history of a CS can make subsequent pregnancies less safe for those hypothetical future babies (and mothers). And a straightforward vaginal birth is safer for a woman than a CS. But nobody gets to choose a straightforward vaginal birth, it’s luck of the draw (although how the deck is stacked can be estimated depending on factors such as maternal age, fetal position, and especially prior labor history). And a planned CS is safer for a woman (and of course baby) than a trial of labor followed by a crash CS. Then, of course, we have to factor in the future. In my own case, having my baby vaginally allowed me to skip the surgical risks of a CS. Unfortunately I did end up suffering one of the known risks of vaginal birth: pelvic floor damage. Now a need a repair surgery that is a much higher risk surgery than CS is.

Really, comparing TOL vs. planned CS is a lot like comparing breast vs. formula. There is no clear winner as to which is safer. One size does NOT fit all.

moto_librarian

What about all of the long-term morbidities associated with vaginal birth for women? Not a single healthcare provider discussed the potential for significant pelvic floor damage. I have a rectocele and significant nerve damage. I have to splint every time I have a bowel movement, and I have accompanying issues with bowel urgency and occasional incontinence. Since I’m not even 40 yet, this isn’t some sort of age-related problem; it’s from vaginal birth. For now, I deal with the embarrassment and discomfort because I can’t agree to an 8 week recovery where I can’t lift anything or work, but once my youngest is a bit older, I will have the repair done. I’m also hoping that an interstim device will help the urgency and incontinence.

The Bofa on the Sofa

Why “far”? And remember the benefit of doing procedure X is that you don’t have to face the risk of procedure Y.

And to what extent do you think the benefits do not exceed the risks when it comes to c-sections?

Dr Kitty

Benefits do apply to individuals right?

TO ME the benefit of a safe CS delivery far outweighed any benefit of VB.

Again, was my experience, specifically, “unfortunate”? If so, why? If not, want to row back on your previous statement?

NICE advises that if women request CS, and after being given information about the risks and benefits still find VB unacceptable, elective CS should be offered.

nikkilee

Benefits increase chances of good things happening; or, to say it another way, they reduce the risk.

Dr Kitty

No babe.
Not having to experience labour was a BENEFIT.

I don’t want to experience labour pains.
I don’t want to experience a VE during labour.

Getting two babies without ever having a contraction or a vaginal examination was a benefit.
Not about risk reduction, actual things which I was happy about.

You still haven’t answered my question.
Was my experience “unfortunate” or not?
Are you sad for me?
Do you think I made a bad choice?

Go on, tell me how you really feel.

Azuran

So, you support bodily autonomy, but only when you agree with the choice?
See, that’s not how informed consent works. Kitty knew the risks and benefits of both possibility, and chose what she wanted.

nikkilee

I support autonomy and informed choice; whether I agree with the choice or not is not important. Informed choice about infant feeding includes discussing the risks of formula feeding, and the need for support for new mothers no matter what is the infant feeding choice.

Azuran

Ah, but informed choices about feeding also includes the risks of Breastfeeding, and discussion about the REAL proven benefits of breastmil, not the imaginary ones.

Also, why are you bringing up breastfeeding? We were talking about c-section here.

Chi

What about the risks of breastfeeding? Should women be told about those? Or just ‘supported’?

Because breastfeeding ALSO carries risks which include but are not limited to:

1) Risk of readmission to hospital for severe weight-loss and dehydration if the mother has an inadequate supply.

2) Diseases being passed through the breast milk (rare but still a risk)

3) Some medications are incompatible for breastfeeding because they DO get passed through the breast milk and CAN have a negative effect on the baby.

Should women be informed of those risk too?

And I am genuinely curious as to what you think the ‘risks’ of formula are. And I’m not talking about improperly prepared formula. I’m talking about formula properly prepared with clean water in an industrialized country.

“Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes.”

In other words, there MAY be links but further studies will have to be done. Also they mention that several of the studies didn’t properly control for confounding variables and those that did didn’t show any statistically significant differences between breastfed or not.

As for the table, again, I would want to go through each of the studies that they are drawing these conclusions from and actually read the methodology and controls myself to make sure there aren’t any confounding variables (which there inevitably is).

Don’t have time right now for that kind of in-depth analysis because I have a cranky 2 year old to deal with, but maybe if she goes down for a nap. In the meantime if anyone else wants to take a crack at it, I believe this is the table Nikkilee is talking about:

No, see, that’s what the debunking means. There isn’t evidence. There’s badly put together studies with massaged data, or ones that reference global things but then extrapolate to areas where that isn’t appropriate (ie, in the US we have clean water so formula is safe). There isn’t actually any evidence that breastfeeding does much in developed countries other than slightly cut down on the number of colds a baby will get. That’s … a very small benefit.

nikkilee

Show me the debunking. The Surgeon-General is the leading MD in the nation, fully aware and skilled in the use of evidence. The AHRQ report was put together by the our health authorities. You are free to disbelieve, and that doesn’t change the evidence. Risk of SIDS has been calculated for each additional month of breastfeeding; risk of breast cancer has been calculated the same way. Breastfeeding has health benefits for mothers also. Again, no guarantees for total risk reduction, and a reduction of risk that is enough that it is worth doing, http://www.evidentlycochrane.net/lancet-breastfeeding-series/

Heidi

Did you actually read that whole 415 page AHRQ or did you skim it until you saw something you liked? No, I didn’t read its entirety but I saw a lot of C’s which meant the study sucked and quite a bit of meh, we can’t say there was much evidence to support breastfeeding for x benefit. The sibling study did debunk a few of those claims.

You need to be honest again. YOU think the benefits are worth it. You don’t really admit formula has a myriad of benefits. What you aren’t considering is the benefits to formula trump the breastfeeding ones for many women. Support paid maternity leave, support anti-racism, support healthcare (versus your idea that insurance companies should charge us formula feeders/formula fed more; who is that really enriching and who is that hurting?), and then let the chips fall where they may in regards to breastfeeding rates. I am very confident our population’s health will exponentially be better as a result, even if all women with fullterm babies formula fed. Hey, I should just do like Bartrick and use my speculation as proof!

I find you hurtful and frustrating. I cannot breastfeed and it angers me a great deal when I’m barraged with information that my child is at increased risk for all the bad things when the truth is he is very healthy and happy. Exaggerating your benefits (not mine, not hers) and other aspects fuels a culture where some people think it is okay to insult women if they see evidence of formula use.

nikkilee

Evidence is not a guarantee of anything; evidence is a foundation for practice. I have never insulted anyone; that isn’t my intention and never has been. I apologize for causing you pain.

Heidi

There are tons of factors, pros and cons for both feeding methods. Whatever practices we encourage also need to be feasible. We know in the absence of breast milk, commercial formula prepared correctly is a great option that allows babies to thrive. We know many women simply can’t produce enough milk (we know cows specifically bred for lactation have a 10% failure rate. We don’t breed humans for lactation.) We know that right now we live in a society that doesn’t place a whole lot of value on equality or parenthood. We should definitely fix those but we shouldn’t be aggressively and unabashedly pushing practices that are only available for the privileged. While there are laws that allow a woman to pump at work, a workplace does not have to pay her for her pumping time. So women are paying to pump and can be paying way more than they would be for formula.

We are never going to get a study that can accurately access breastfeeding benefits because breastfeeding is always going to be more accessible to people who are already advantaged in many ways. However, the sibling study was the closest we could get to a tightly controlled study and it showed the benefits might be almost wholly socioeconomic. I’m firmly middle class and comfortable financially. I am a stay at home mom. Getting pregnant was a decision we made. I had been taking prenatals for folic acid months before we were even sure we wanted a child because folic acid has proven health benefits. We were able to put money and energy towards preparing for the baby’s arrival. I spent my free time researching child safety, we took childcare safety classes, we took infant CPR. We had all the necessities months before he arrived. We took our car seat to a safety check. When the baby arrived, my in-laws stayed over a week to help us out. Since my husband has a high enough, salaried position where he works, they let him take a few weeks off when the baby was born. This is not their policy on the books and not something they offer to many of their other employees. We switched off night feeds so we wouldn’t find ourselves in a dangerous situation of falling asleep while holding a baby. There was nothing in his crib, we knew not to use blankets or bumper pads (and if you look at reports of SIDS, most the time there are objects found in the crib like pillows and blankets). We knew the correct way to hold him during a feed to greatly reduce the risk of ear infections. We can easily afford our child’s formula. We have never been in situation of running out of formula because WIC didn’t give us enough so we never even considered watering it down or perhaps feeding him formula that has been out for hours. We are both literate so we could easily read the back of the can and understand how to prepare it. I volunteer with an adult literacy program and you’d be surprised at the statistics! We should never assume anyone may be able to read the back of the can and understand it. Even if a mom intends to EBF, we don’t know what the future holds. We should not be discharging women without formula prep education.

If I couldn’t afford childcare classes or freetime, I’d be depending on some outdated advice from family. I’d probably have bumper pads on my crib because he can’t bump his poor head, wrap the baby up in multiple layers because babies are always cold and can’t overheat, put him to bed with a bottle because that’ll soothe him. If I smoked, I wouldn’t think anything of doing it indoors. My grandmothers both smoked indoors. I’d be putting cereal in his bottle at 2 or 3 months. I would probably do a lot of things that over time have been proven not to be best practice and sometimes fairly dangerous. However, knowing better and being in a good economic situation, I got the benefits plus some breastfeeding supposedly offers.

I am 100% for creating an environment where breastfeeding is possible for any woman who wants to do it, but not because I think breast milk is the end all and be all of infant health, but because that would be a environment that promoted equality. I have no idea what percentage of women would actually breastfeed, though. Even women who can physically do it and have the time and money to do it sometimes decide it is not what they want to do. Why not focus our energy on things we know are beneficial and anyone and everyone can implement? We know not everyone can implement breastfeeding, and we know there are so many overlooked or yet to be understood confounding variables in breastfeeding studies.

The Bofa on the Sofa

Even women who can physically do it and have the time and money to do it sometimes decide it is not what they want to do.

I have told our story before, and I want to hear from nikkilee or anyone what is wrong:

When our oldest was born, my wife was nursing along with pumping. And we had a decent supply of pumped milk, but she was never able to pump more than a few ounces.

The reason she was pumping was because she was planning to go back to work. She didn’t need to work for us to survive, although it helped, but she wanted to work to keep her sanity. She didn’t like being stuck at home with the baby all the time. However, more money also helps, because we know that, like it or not, affluence benefits kids. My wife could make enough working 2 days a week to pay our mortgage. Heck, when the kids were in daycare, she made enough to pay for daycare just working Monday morning. The rest was all profit.

It wasn’t a problem with her working because I was on leave from my work and was able to stay home when needed. But in order to do that, I had to be able to feed a bottle. Now, we had pumped breastmilk in the freezer, and I could use that, but it was in 3 oz bags, and our normal bottle was 6 – 7 oz. My option was to use up 2 bags of breastmilk OR to mix in with formula. So I used a mixed bottle, of half formula, half breast milk. By doing that, I could spread out our supply of pumped milk and could keep using it all the time until he quit nursing at 9 months. If I didn’t do that, I would have had to give bottles of just formula probably starting at about 7 months.

So we combo fed.

Now granted, we didn’t have to. My wife could have stayed home and breastfed the whole time. It would have driven her up the wall, and it would have cost us thousands of dollars in disposable income (she worked for about 6 months while breastfeeding, and was probably making $2500/mo at the time. so maybe $15K?). So what’s better: combo feeding (the evil formula), $15K and sanity OR breastfeeding?

If you think this is even a question worth considering, you are deluded.

With the second, things changed a little. He wouldn’t take ANY breastmilk from the bottle at all, so any bottle feeding had to be formula (and no powdered stuff). Also, we had to use daycare, so in the time that she was working, it probably was only a net of $10K/year. But still, daycare/formula feeding/sanity and $10K vs breastfeeding? Not even close.

I want someone to try to claim otherwise.

(btw, both kids were EBF when my wife was around, they only did formula when she went to work)

Daleth

Show me the debunking.

We already posted a link to the discordant sibling study, but here it is again. I’d be interested in your take on this.

The abstract says–I’m paraphrasing, but the full quote is below–that studies have shown 10 significant benefits to breastfeeding that persist long-term (i.e., in children aged 4-14). However, when you compare siblings where one was BF and the other formula fed–and the reason you examine siblings is to make sure the “breasfteeding benefits” you’re seeing are caused by breastfeeding, rather than by the fact that on average breastfed kids are in a higher socioeconomic class than formula-fed ones–those benefits disappear. That means the benefits are caused by higher socioeconomic class, not by breastfeeding.

Quote from the abstract:

“Results from standard multiple regression models suggest that children
aged 4 to 14 who were breast- as opposed to bottle-fed did significantly
better on 10 of the 11 outcomes studied. Once we restrict analyses to
siblings and incorporate within-family fixed effects, estimates of the
association between breastfeeding and all but one indicator of child
health and wellbeing dramatically decrease and fail to maintain
statistical significance. Our results suggest that much of the
beneficial long-term effects typically attributed to breastfeeding, per
se, may primarily be due to selection pressures into infant feeding
practices along key demographic characteristics such as race and
socioeconomic status.”

The analysis of the 11 outcome measures is detailed and done in depth. However, the breastfeeding definition is weak. “We rely on two independent variables to capture infant feeding practices. Breastfeeding status (yes/no) was coded as 0 if the mother did not breastfeed and 1 if she breastfed him/her for any length of time.” Breastfeeding duration was not described in any detail. So a mother could have breastfed one baby for two days, or two weeks, and the next baby not at all, yet their health outcomes would be evaluated as equal. This is the big flaw in that study. Labokk and Krasovec published a formal definition of breastfeeding that is an internationally accepted guide: exclusive or full, partial (3 levels), and token or minimal. The WIC definition of breastfeeding, “an average of one breastfeed a day” would be called ‘token’ breastfeeding and would not confer the same health benefits as a baby exclusively breastfed for 6 months.

swbarnes2

This is a big study, with 1700 discordant siblings. If you are sincerely arguing that the effects of partial breastfeeding are so weak and small that a 1700 child study child study can’t see them, they you are pretty much admitting defeat. When your best argument is “Well, maybe most of the women who said they were breastfeeding were barely breastfeeding”, you are pretty much admitting defeat.

Can you explain why this this study DID see socioeconomic effects, and not your beloved breastfeeding effects? Are you honest enough to truthfully answer “Because socioeconomic factors matter a great deal more than breastfeeding”?

nikkilee

Cohort from 1986 to 2010; in the late 80s, there wasn’t the emphasis on exclusivity as there was in the 90s. We don’t know how many children were partially breastfeeding, or for how long. We don’t know how many were doing token breastfeeding or how many were exclusively breastfed, or for how long. If the authors had gathered the breastfeeding data with the same detail and focus as they did the analysis of outcome measures, this would have been a landmark study. That omission is a huge flaw.

Roadstergal

Ah! Yes, the focus on exclusivity in the ’90s. As I mentioned above, even per your own unsourced numbers, the exclusivity rate these days is in excess of the _initiation_ rate of breastfeeding in the ’70s. All of this liquid gold flowing into the mouths of babies must be paying off big-time by now.

Show me a health benefit that all of this BF is giving us at a population level. If BF is as important as you say, show me a way in which the kids today are overall better-off than my generation when it comes to obesity, asthma, chronic disease, food allergies… Bueller?

SIDS risk is reduced by introducing a pacifier- no breastfeeding necessary. I disbelieve bad or non-existent evidence. And the cancer risk is quite small and exists for all people who never become mothers- should women stimulate milk production to reduce their breast cancer risk? No, I think not. It is a benefit, but it is a tiny one, and it’s certainly not one worth the pain to women and risk to infants if breastfeeding isn’t working out.

All other things being equal breastfeeding is best by a very tiny bit. The problem is that all other things are never equal, and formula is a perfectly good method of feeding a baby. You seem to think that people saying breastfeeding isn’t perfect means that we are against it; no, we’re not. We’re against shaming women who don’t do it, we’re against overhyping it, we’re against ignoring the barriers to women’s autonomy that BFHI and pushing breastfeeding presents. We are not against people choosing to breastfeed if that’s what works for them. We are against people pushing breastfeeding on women who don’t want to or can’t, because the proven benefits of breastfeeding are tiny and the costs of pushing it are huge.

Formula feeding has been shown to double the risk of SIDS in a meta-anlysis by Vennerman, as well as in much previous research. The AAP just raised breastfeeding to #3 on the A-list of SIDS protection recommendations. A-level recommendations
Back to sleep for every sleep.
Use a firm sleep surface.
Breastfeeding is recommended.
Room-sharing with the infant on a separate sleep surface is recommended.
Keep soft objects and loose bedding away from the infant’s sleep area.
Consider offering a pacifier at naptime and bedtime.
Avoid smoke exposure during pregnancy and after birth.
Avoid alcohol and illicit drug use during pregnancy and after birth.
Avoid overheating.
Pregnant women should seek and obtain regular prenatal care.
Infants should be immunized in accordance with AAP and CDC recommendations.
Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.

Ah, no, breast cancer is not reduced by 1/8 by breastfeeding. 1 in 8 women will get breast cancer in their lifetimes. Those are two very different numbers. Please link to the actual academic study (or abstract if it’s hidden behind a paywall) showing the protective impact of breastfeeding. Also, is that protective impact more important and impactful than the negative health impacts of a screaming baby (stress!), going back to work on time (money helps health, job is health insurance), and so forth?

The AAP list is interesting. Again, though, I ask for links to the studies showing that breastfeeding reduces SIDS, properly controlling for confounding factors. I’ve noticed that the AAP will sometimes make recommendations based on pretty shitty studies (see: peanut allergy prevention), only to reverse course once enough debunking has occurred. This is how science works, and I approve of that sort of course correction. However, I’m trying very hard not to be hyperskeptical about breastfeeding, and you can help by providing the links I’ve requested. Thanks!

The German paper controlled only for maternal smoking during pregnancy – not maternal smoking after pregnancy, or smoking by anyone else in the house. They didn’t even control for previous siblings lost to SIDS, which is a risk factor! I have my doubts about their SES surrogates, too. I also didn’t see any mention of controlling for mouth or respiration issues that would make breastfeeding difficult or impossible, and could in parallel elevate SIDS risk. To that point, note that the comparison wasn’t breastmilk vs formula, it was bottle vs breast.

The meta-analysis only had two studies in it that had multivariate analysis at all, and one of the two had an OR that crossed 0.
Overall, some decent preliminary data, but with caveats.

Now, let’s look at something more recent – PMID 26175065, 2016. Meta-analysis of breastfeeding and pacifier use. Read it and let us know what you think.

(Spoiler alert. Pacifier use is as good if not better than BF at SIDS risk reduction; of five examined RCTs examining the effect of pacifier use on breastfeeding, four found no negative effect.)

nikkilee

AAP finds both recommendations to have A level evidence.

Roadstergal

That’s exactly what we’ve been saying, nikkilee. Whatever risk reduction for SIDS is conferred by breastfeeding, it’s conferred at least as much by pacifier use. Do you tell women that? “Breastfeeding reduces the risk of SIDS, but so does pacifier use, and pacifier use won’t interfere with breastfeeding if you do want to give BF a go?” At your ‘classes,’ do you emphasize that?

nikkilee

“According to Hauck, one SIDS death could be prevented for every 2,733 infants who use a pacifier when placed to sleep (3). The AAP recommendations are as follows: Offer a pacifier at nap time and bedtime. Do not force an infant to use a pacifier.” Breastfeeding cuts the risk of SIDS by 30 to 50 %.

Roadstergal

I’m trying to decide if you’re really as dense as you appear when you answer a fairly direct question with something completey tangential, or if this is all a cynical ploy to, as mentioned above, sow enough FUD to keep yourself in business.

maidmarian555

Definitely cynical ploy. She knows exactly what she doing, dripping NCB poison and doubt all over the Internet. Of course, she won’t ever have to pick up the pieces when that poison has a real-world effect on women. She won’t be there to dry their tears when they’re left abandoned by her community because they ‘failed’ motherhood before it even began by having an epidural or c-section or by being unable to breastfeed. These cretins never are. It’s disgusting. And then if mum makes the wrong decision and loses her baby because she refused intervention or accidentally starves her baby because she believes them when they say formula is poison? All her fault. Stupid mum. She should have known in that situation to trust the provider they all told her not to trust. I wonder how many dead and damaged babies Nikki Lee has under her belt? I guarantee she doesn’t even take responsibility for one of them. Not one. All mum’s fault.

momofone

How exactly would one “force an infant to use a pacifier?” I don’t know about your infants, but mine either liked what he liked, or refused. (Fortunately he loved his pacifier.)

Empress of the Iguana People

My boyo certainly had very strong opinions on pacifiers. The round ones were fine for a couple months. The slanted “more like mom” nipples were vile and must be spat out immediately.

nikkilee

In the infant massage classes I teach, I’ve seen one parent holding the infant’s head, while the other parent holds the pacifier in the screaming infant’s mouth.

So pacifiers as a whole are wrong or a bad thing, because you saw someone use it wrong, or because there are obscure contraptions available to use it wrong?

nikkilee

Forcing, as I have seen, or strapping it in place is wrong. In the NICU, to keep a premie calm or to stimulate release of digestive juices during tube feeding are evidence-based practices. Every tool has its place. Is it common knowledge that pacifier use is linked with ear infections, even when smoking and day care are controlled for?

How do you get that breastfeeding reduces the risk of SIDS by 30-50% from a quote talking about pacifiers?

Heidi

If my math is right, pacifier wins. If you have 10932 (a number easily divisible by 2733) babies, usually 5 would die of SIDS. If four are saved by pacifier, you down to 1 baby dead. If you use your liberal number of 50%, ~2.5 babies are still dead.

The Bofa on the Sofa

It looks like from the stats above, that the baseline rate is 4/10000, not 5. So if breastfeeding cuts the incidence by 75%, then the number needed to breastfeed to prevent a death is more like 3300.

The Bofa on the Sofa

Wow, talk about disconnect!

How many babies need to be breastfed to prevent 1 SIDS death?

nikkilee

Back in the 80s, when I first starting teaching, this was what was said: that 3 breastfed babies would die of SIDS while 75 formula fed babies would.

I couldn’t find such a breakdown when I looked this morning. Studies today look at risk reduction by comparing cases with matched controls.

“Combining the results, the researchers found that the rate of SIDS was 60 percent lower among infants who had any amount of breastfeeding compared to those who didn’t breastfeed, and more than 70 percent lower in infants that been breastfed exclusively – without any formula – for any period of time.”

The Bofa on the Sofa

Which still has no bearing on your pacifier results. See Heidi’s analysis below. The basis for the analysis is a SIDS rate of 5/10000. If that is right, then the analysis is right

Azuran

Or, you know, something you learned 37 years ago isn’t valid today.

Breastfeeding and pacifier will cut the rate of SIDS about the same. But you are implying that while we shouldn’t force a baby to have a pacifier, but we should force women to breastfeed.

Dr Kitty

A college education cuts the risk of SIDS, as does marriage, and earning a higher than average income and in the USA these are also associated strongly with breastfeeding.

Did the study you quote from (but didn’t link to) control for family history, socioeconomic status, education, smoking status, type of housing, bedsharing, drug and alcohol use by either parent?

Were the cases matched comprehensively or just by gestational age and breastfeeding status?

Empress of the Iguana People

they also weren’t recommending babies sleep on their backs in a bare crib yet.

Daleth

“Combining the results, the researchers found that the rate of SIDS was
60 percent lower among infants who had any amount of breastfeeding
compared to those who didn’t breastfeed, and more than 70 percent lower
in infants that been breastfed exclusively – without any formula – for
any period of time.”

That seems to be the same definition of “breastfeeding” as the one you criticized in the discordant siblings study. Now, since the study you’re citing says something you want it to say, you’re fine accepting the idea that “any amount of breastfeeding” has a massive impact on SIDS rates?

And let’s look at the numbers. Is the difference between 60% of a very tiny thing and 70% of a very tiny thing a statistically significant difference? Can you point me to any evidence that it is, and perhaps more importantly, any evidence that even one suck at mom’s boob (“any amount of breastfeeding”) can cause SIDS rates to plummet 60%, while EBF only adds a further 10% to that number? Does it even make sense to claim a causal relationship exists there? If, as you’ve essentially claimed in other posts, breastmilk’s health effects are dose-dependent, how can you take this study seriously? The fact that you do suggests you’re subject to confirmation bias (“it says what I already believe, therefore it must be true”).

And by the way, here are the stats on SIDS:

“Sudden infant death syndrome (SIDS) rates declined considerably from
130.3 deaths per 100,000 live births in 1990 to 38.7 deaths per 100,000
live births in 2014.”https://www.cdc.gov/sids/data.htm

Also, check out this chart. The yellow and black bars represent breastfeeding rates (initiation in the hospital vs. continuation at home), and as you can see, the rate of BF’ing in the US didn’t change dramatically in the years covered (1985-1997). But the blue line across the top represents SIDS deaths, which DID change dramatically over those years–as you can see, they started dropping after the 1992 “Back to Sleep” campaign. Hmm. So what do you think–if you’re being intellectually honest with yourself–caused the drop in SIDS rates? Breastfeeding, or safe sleeping?

It only ends up being worth it if the downsides of the intervention aren’t worse than the tiny number of cancers prevented. Furthermore, if the same effect can be achieved via less intrusive means (hormonal BC to prevent ovulation), why push breastfeeding as a cancer preventative at all? It’s a nice plus if you want to breastfeed, but it’s definitely not a reason to force yourself through painful, traumatic, or unpleasant experiences if breastfeeding isn’t working out.

If, for example, the benefit is 0.00001% of breast cancers prevented, it’s very much not worth it. The likely benefit to any individual is nil, as I know you know from your discussion of population vs individual outcomes, so why put oneself through a terrible experience (if breastfeeding winds up being terrible- obviously it is usually not) for likely no benefit?

moto_librarian

Then why can’t you show it?

fiftyfifty1

“Breastfeeding has few risks.”

Oh spare me. It doesn’t matter how many different risks something has. If the number of risks mattered, cyanide would be pretty safe, because it only does one bad thing–poison people to death. No, what matters is how OFTEN risks occur and how SERIOUS the consequences are. And insufficient breastmilk happens a lot, and the consequences can be dire.

Heidi

Just quit saying you are for autonomy and informed choice because that is clearly not what you are for. You circumvent actually providing a clear yes or no answer when asked if women should be informed of the risks of breastfeeding. You want to inform women of a one-sided view of breastfeeding. You want what you think are benefits to be given, but your benefits may not be another woman’s benefits. You don’t get to decide what benefit trumps the other and you don’t get to decide which ones to disclose and which ones to not disclose if you are really for autonomy and informed choice.

Breastfeeding is not even close to tangible for many, many women. If some women choose to EBF, they risk losing their jobs then their shelter, food and other necessities. You can say all you want that women should have paid maternity leave, but you know as well as me that is not happening anytime soon. Even if women get maternity leave, how many children does she have to take care of at home or what other responsibilities may she have? I haven’t heard you say a word about paternity leave, but even that surely wouldn’t guarantee anything (the father could be out of the picture, incarcerated, dead, etc.). Some women absolutely do not feel comfortable nursing in public. Guilt tripping them with your one-sided view isn’t helping them nor their babies. Some women are victims of sexual abuse and breastfeeding would be very traumatic for them. Again, you aren’t being very helpful, in fact you might be detrimental to women, exaggerating risks of formula and overstating questionable benefits of breastfeeding. For some women, the sensation of breastfeeding may be unbearable. It’s cruel to have women do something multiple times a day, for a year or longer, that disgusts them.

And quit brushing aside the very real consequences of not enough breast milk. You yourself have posted studies that show starvation/dehydration readmissions are not that rare of an occurrence with exclusively breastfed babies! Some studies show 3%, some show 5%. And heck, you can’t even prove it wouldn’t be higher because you have no way to ultimately prove who is sticking to exclusive breastfeeding once they leave the hospital. When you go to the store to buy a can of formula, you don’t show your ID! Your child’s pediatrician might ask, but you don’t have to tell him or her the truth. I probably didn’t give my pediatrician an accurate answer. I said I was probably giving him 30% breast milk but that was a very rough estimate because my output and dedication varied daily. If I thought someone was asking to be a judgy snot, I just answered, yes, I was breastfeeding because it was the truth. It was none of their damn business he got formula.

See, I think if you actually genuinely cared about the plight of disadvantaged women, you wouldn’t be what you are. I’ve seen your website. You cater to upper middle class women who can throw money at unproven, maybe even dangerous, “treatments” for an easily solvable problem – give that baby some formula and move on. Even in circumstances where the problem can be technically overcome in regards to lactating enough, it doesn’t always mean it’s worth it. Women deserve sleep, personal space and happiness after all. If the benefits of breastfeeding aren’t there or that great and formula feeding is a reasonably safe and healthy alternative, where is your piece of the pie? You gotta make it sound dire because only then will women maybe throw their money at you out of desperation. I’m going to say, it makes you a big hypocrite every time you post a study that you think makes some great claim about breastfeeding or vaginal birth as proof when you don’t otherwise hold yourself to that standard. How do you justify practicing homeopathy and craniosacral therapy?

nikkilee

Women choose to hire me. Society is not supportive of women breastfeeding; when 23% of new mothers have to return to work within 2 weeks of giving birth, EBF is impossible. However, she can pump. Or, she can breastfeed twice a day and do that for years. Breastfeeding is not all or nothing in a mother’s life. All of these things do not change the facts. Two things can be true at once.

Heidi

There you go dancing around anything anyone says again.

Roadstergal

Her dancing makes sense if you consider that her main goal is to sow just enough FUD to continue to make a good living.

Heidi

Reading her response to me, I gotta wonder did she even read and comprehend what I wrote? It was long for a comment I know, but she supposedly read and analyzed that 415 page document she posted so surely a few paragraphs are nothing to her?

momofone

But when my doctor and I are consulting about decisions, we are making them for an individual. Naturally we are weighing MY risks vs potential benefits/other courses of action.

MaineJen

“The art of delivering a vaginal breech” results in a 5% death rate, according to MANA. No thanks.

nikkilee

The average client stays with an insurance company for 4 years; as supporting breastfeeding is an investment in the future, an insurance company doesn’t want to invest in anything that won’t give it savings quickly. That’s what I heard today as a reason that insurance companies aren’t supporting breastfeeding. Whereas obesity and tobacco cessation programs reap benefits very quickly.

I work for an insurance company, though not a health insurance one. That is utter bullshit. A healthier cohort is going to be healthier through time, and even if people leave, they will come back. As an insurance company, you support things that work overall. Smoking cessation doesn’t lead to great outcomes immediately- the full effects take 20 years to see! Yet insurance companies support it because it works.
Insurance companies aren’t supporting breastfeeding because the statistics and actuarial analysis don’t support it being a health improvement. It’s that simple.

Roadstergal

Still waiting to have shown to me what population-level benefits my generation missed out on from not tasting that liquid gold.

Still waiting to hear what population-level benefits the US has over low-BF-rates Japan.

nikkilee

What generation are you?

Roadstergal

We discussed this above, twice. Stop stalling and answer.

Azuran

Minimal logic would indicate that Roadstergal if from the time when breastfeeding was at an all time low.

Azuran

The answer is actually pretty simple: They don’t care because it doesn’t matter.

RMY

>In Japan, how long a baby breastfed was part of a school entrance history; I don’t know if that is still true.

Please cite a source for that extraordinary of a claim. Google results don’t support that, and my (not perfect, but not totally ignorant) understanding of Japanese culture makes that claim sound suspicious.

Daleth

Please cite a source for that extraordinary of a claim. Google results don’t support that, and my (not perfect, but not totally ignorant) understanding of Japanese culture makes that claim sound suspicious.

I’m fairly familiar with Japanese culture too, even studied the language to the point I was able to write a 10-page paper in Japanese, and I agree with 99% certainty that that’s false. I eagerly await Nikilee’s source, which will never come.

50%, folks! And that’s infants, who have the highest EBF rates. And that’s in a country where mothers typically do not have jobs, not even part time, so that obstacle to BF’ing doesn’t exist. Single motherhood is almost nonexistent (it’s heavily stigmatized, much like it used to be back in the 1950s here, resulting in a high rate of abortion); mothers are almost always married and supported by their husbands, so all they do is keep house and take care of their children. And to succeed in Japanese society you have to be fiercely competitive about schooling, so if BF’ing had anything to do with school entrance you can bet the rate would be closer to 100% than 50%.

Quote from the article: “Asked about their breast-feeding worries, with multiple answers allowed, 40.7 percent of the [Japanese] mothers said they can’t tell whether their babies are getting enough breast milk, followed by 20.4 percent who said their breast milk supply may not be enough and 20.0 percent who said breast-feeding is burdensome.”

Roadstergal

And that’s why Japan has such an epidemic of chronic disease and obesity! Oh, wait…

Nick Sanders

Or it could be you’re chasing shadows, because the insurance and formula industries have nothing to do with each other. But that would mean you would have to reevaluate your premises…

Daleth

Could it be that in a corporate nation, industry dominates, and that the
billions of dollars made by the formula industry speak loudest?

No. The insurance industry doesn’t care if some other industry is making money. It cares if the insurance industry is making money.

And here’s how the health and medical malpractice insurance industry makes money: they study, in excruciating detail, what makes people healthier/less likely to be injured and what makes them less healthy/more likely to be injured. And then they do their damnedest to tailor insurance coverage to those realities.

For instance, even on Obamacare plans, smokers and older people pay higher premiums. And medical malpractice insurance policies have rules: for instance, doctors have to follow evidence-based care, and home birth midwives generally don’t have insurance because insurance companies won’t cover them if they do dangerous things (deliver breech babies/twins/etc. at home, fail to have clear risking-out criteria, etc.). The more risky things a healthcare practitioner wants to be allowed to do, the more expensive their insurance will be, and at a certain point they won’t be able to get insurance at any price.

Funny how no insurance plan I’ve ever seen even mentioned breastfeeding, much less tried to promote it.

nikkilee

Insurance plans in my region are paying for lactation consults, and pumps, specifically some BC/BS plans and Aetna. Other companies, such as Tricare, are doing the same; depends on what region one is in.

Heidi

They are doing that because right now they are required to under the Affordable Care Act, not because they think it will save them money.

Azuran

You are confusing 2 different things. What the insurance company covers is not an indication of what is healthy or best. It’s often dictated by laws.
What matter is what they are asking you when they decide if they want to insure you and for how much. And breastfeeding isn’t part of those questions.

nikkilee

It should be.

Heidi

Yeah, I mean studies have actually failed to show any worthy benefits, and exclusive breastfeeding has a much higher rate of needing to be hospitalized for jaundice, starvation and dehydration, but DAMN, we get yet another chance to shame women about something they either weren’t able to do or didn’t want to do! Who could turn an opportunity down like that? Obviously, not you!

Who?

You are forgetting to take account of the overwhelming importance of all nikkilee’s feelings, and the maintenance of her business model and income stream.

When you adjust for those her position will become a lot clearer.

Roadstergal

From the nikkilee department of Because I Say So.

Roadstergal

Okay, nikkilee, this is the thing I’ve never gotten a good answer for.

My generation was the nadir of breastfeeding. We had, IIRC, less than 30% breastfeeding rate. It’s over 80% now (this is all US, of course). Given the massive health benefits you say breastfeeding has, my generation should be riddled with chronic diseases, allergies, asthma, obesity, and should be so stupid we can’t get our pants on the right way in the morning. Why is the current generation, with all of the boob juice it’s getting, so much more prone to these issues that breastfeeding is supposed to prevent?

nikkilee

80% is initiation rate, the baby has had a sip at breast once before hospital discharge. Exclusivity and duration rates are much lower, 24% at a year; 44+% exclusively at 3 months. . .

Roadstergal

Exclusivity at 3 months that exceeds the _initiation_ rate in the 70s. So FAR more babies are getting any breastmilk at all, and way more are getting nothing but tit juice for months. Again, where are all of the health benefits?

kilda

it’s the vaccinations, silly.

Nick Sanders

I blame reality shows.

Roadstergal

I blame the garbage they call ‘music’ these days. Git offa my lawn!

The Bofa on the Sofa

I know. In my day, we had great songs like Hot for Teacher by Van Halen and Pass the Duchie by Sonic Youth and groups like Kajagoogoo and The Hooters. When I was really young, it was about Smoking in the Boy’s Room and Afternoon Delight. That was music, not this crap they listen to these days!

KeeperOfTheBooks

Though I do wonder if breastfeeding is a symptom of the speshul snowflake attitude I saw so much of back when I worked in higher ed. Statistically, a LOT of them were breastfed, probably in part because, in some instances, mom figured “no matter what I have to sacrifice, only the best for my kid even if the benefits are miniscule!”.
I frequently had to deal with PARENTS of 20-something-year-olds whinging at me about how unfair it was that they had to be on time for state-level standardized tests and how meeeeean I was to not admit them and “restart” the test just because they thought “The test starts at 9 AM; no students will be admitted to the hall after 8:45 AM” meant “show up sometime around 9:15 cos it’s close to 9, right?” Fortunately I had an awesome boss of the sort who was always happy to tell parents to take a flying leap, but you get the picture.

sdsures

I think I would have gone full Hulk on parents like that.

KeeperOfTheBooks

Believe me, I was tempted!
The most idiotic part is that they weren’t doing their kids any favors at all. At some point, the real world was going to hit them, and hit them hard.
(See: the guy who, when my sister fired him for not actually working/showing up late/being a complete nuisance in general, came back with his mom to argue with her. Did I mention that he was nearly thirty?! And then he finished off by hitting on sis on his way out the door…)

Dr Kitty

You want to see some of the letters I’m asked to write around exam season for kids to try and get them special consideration or extra credit.

I charge £15 for those letters ( less if I like you and think paying for it will be a genuine hardship) and yet, funnily enough, I politely decline to write letters that take the piss.

I do have some professional pride left.

“X’s younger brother was dying from leukaemia during his exams” -that’s a free letter.

“Y had a new puppy”- not so much.

sdsures

I would have smacked him across the face.

KeeperOfTheBooks

They rarely had the guts to say anything but “oh, okay” when I turned them away. Foolishly, they usually preferred to have Mommy email my boss to whinge about my following the rules. Given that my boss didn’t want our certification in that area to get yanked, and that he was the chair of the department to which these idiots were applying, he’d just kind of salivate with a really nasty grin on his face when he’d report that he’d gotten another email from Speshul Snowflake parent. 😀

Azuran

If it was important, it would be.
It isn’t because it’s not important. Deal with it.

Who?

Exactly.

Insurance won’t cover homebirth-or often vbac-because the numbers tell them that there is no way to price the risk.

If insurers thought breastfeeding was first, reliable enough to put a price on, and then provided a benefit they could quantify, they would be all over it.

And apart from all that, how on earth would the insurer know, years down the track, whether the person reporting was telling the truth?

Roadstergal

The one valid reason insurance companies would have to track breastfeeding would be to track babies that were EBF past 6 months, as they’re at greater risk for food allergies. Given that this is new consensus agreement based on interventional studies and new recommendations, it will probably take a little time to trickle down.

Heidi

I wonder how Nikki Lee proposes we test babies for breast milk/formula consumption for insurance purposes. I’d just lie anyway.

Roadstergal

How would you be able to lie, given the very obvious, telltale differences between EBF babies and those given dirty, poisonous formula? :p

Heidi

Yeah I’m sure it’ll be just as reliable as the virginity test! And just as ethical too!

The Bofa on the Sofa

Moreover, there is nuance. No breastmilk at all? Less than 1% breastmilk before 3 mos? And if someone started weaning at 4 mos, but had rice cereal made from breastmilk does it count? What if it wasn’t made from breastmilk?

It’s not only worthless, it’s unworkable.

Heidi

Not to mention, it would make insurance even more unattainable to those who are already disadvantaged. I don’t know if NL is that racist and classist or if she really believes boob juice is the answer to well, everything.

Dr Kitty

Nikkilee still won’t answer the very simple question of whether she thinks I, specifically and personally, made bad choices in opting for planned CS. It’s a Y/N question about her feelings so it’s not as if I’m asking for citations to support her position.

Don’t ask her complex actuarial questions!

Heidi

She goes crickets quite a bit.

The Bofa on the Sofa

It’s the same issue we usually face. “Oh there are too many c-sections! Whine! Whine!”

“Really? Ok, which c-section should not have been done? Here’s my story. Should I have done it differently?”

Crickets

Similarly use of formula. I explained yesterday why we used formula, and challenged nikki or anyone to tell us why it was wrong. Nothing. No response.

It’s so easy in abstract to throw pot shots, but when it’s an individual case? Nope.

MaineJen

She also will not tell me whether she thinks the pitocin I was given during labor was unnecessary.

Sarah

I reckon I could tell you both what her answer would be if she had the ovaries to back her pontificating up, if that helps…

Insurance plans in my region are paying for lactation consults, and
pumps, specifically some BC/BS plans and Aetna. Other companies, such as Tricare, are doing the same; depends on what region one is in.

That’s actually thanks to Obamacare, or to use its official name, the Affordable Care Act. If you support these things, better get on the phone to your senators and congresspeople to let them know not to gut or repeal the ACA.

Having said that, the ACA, like all legislation, was written with input from lobbyists. The provisions on breast pumps, etc., were thanks to women’s rights and breastfeeding advocates. I think those provisions are awesome, but they did not come from the insurance industry. They’re in your insurance policy not because the insurance industry did a risk analysis and determined that this lowered health risks, but because a federal law requires them to be in your insurance policy.

Roadstergal

If the ACA is repealed, that stuff is going away the next day. :p

The Bofa on the Sofa

Exactly. There is a reason why the ACA had to mandate certain coverages – because they weren’t sufficiently beneficial to the insurance companies, even if they were beneficial to society on the whole.

Completely off topic, yes, and one hopes you understand that your link doesn’t mean you weren’t embarrassingly wrong.

The article seems to be labouring under the same delusion you were (no pun intended) as it also mentions a WHO recommended rate. Which we all know by now doesn’t exist. There is a little later on in the article attempting to quantify the 10% and 15%, but they don’t appear to present any actual evidence for their vast claims. We see nothing about the risks of vaginal birth, not even any acknowledgment that they exist. Just breathless, awestruck language and a conspicuous failure to tell us whether this reduction in sections has achieved anything other than, well, a reduction in sections. What impact has it had on maternal and perinatal mortality, morbidity? Are there more instrumental deliveries and severe perineal tears because of this policy? The author doesn’t even bother to mention it. Too busy with her anecdote.

Worthless, biased shit, in summary. BellyBelly tho.

nikkilee

The risks to the baby and to the mother of cesarean section are well documented. For the mother: Infection.
Heavy blood loss.
A blood clot in the legs or lungs.
Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure).
Bowel problems, such as constipation or when the intestines stop moving waste material normally.
Injury to another organ (such as the bladder). This can occur during surgery.
Adhesions that may complicate future pregnancies.

For the baby:
Prematurity.
Breathing problems.
1-2% of babies are cut during the surgery.
Increased risk of allergies and obesity, conclusions in some studies.

Of course. And if the mother doesn’t breastfeed, time reverses even further!

Amazed

Oh my god, now I know why the Intruder was the biggest baby in the unit. He must have gained some extra maturity from my mom almost dying in the process after avoiding a CS. He must have been born 1 mo or something.

Empress of the Iguana People

The grandduchess was born a toddler at 38 weeks, vaginally, so maybe that explains it? She was the 2nd biggest kid in the NICU

nikkilee

As it is the baby who starts labor, when it is ready, a baby can be premature by a matter of days. Gestation is not like a train schedule.

The Bofa on the Sofa

As it is the baby who starts labor, when it is ready,

If the baby starts labor “when it is ready,” why are there stillbirths?

You are a fucking monster.

My oldest nephew was stillborn at 41+ weeks. HOW DARE YOU suggest that it was because he was somehow deficient!

God you are an awful person.

You need to step away from the keyboard and re-think your life. Why don’t you do something less evil, like sell cigarettes?

nikkilee

Quite a jump. . .

The Bofa on the Sofa

No, it’s not a jump.

You claimed that babies will be born “when they are ready.” The only conclusion is that a baby that isn’t born wasn’t “ready.” Thus, if she had a c-section before then, it would have been before the baby was ready. If you think we have to wait until the baby is ready, then my sister’s baby deserved to die.

That’s the implication of what you have said, whether it was the intended implication or not.

Amazed

Well, most babies know when to be born. I guess the minority who don’t are just stupid, in nikkilee’s world. And with her whining for using interventions when necessary, it’s clear that in her mind, general rules of prevention do not apply to any situation. One must be dying to warrant it.

Dr Kitty

Lady, we know you’re online, we know you’re reading the comments and you are SELECTIVELY responding to the ones you feel you can rebut, ignoring the others.

You have made a statement about “babies choosing when to be born” that more than one person has told you is offensive and cruel.

This is your opportunity to apologise.

Whether you choose to make a real apology, no apology at all, a mealy mouthed “I’m sorry if some people took offence” non-apology, or whether you remain silent is a test of your character.

Go for it- show us what you’re made of.

nikkilee

We are engaging in a thoughtful discussion, with differing points of view, seeking illumination and understanding.

In the normal situation, the baby seems to be the one to initiate labor. This is not a choice; and, when things aren’t going well, when the benefits of intervening outweigh the risks, then how things are managed will be different.

My intention is to learn, to discuss; never to offend, injure, or insult.

I don’t want to hurt anyone; if what I am writing is taken as hurtful, for that I am truly sorry.

The Bofa on the Sofa

In the normal situation, the baby seems to be the one to initiate labor.

And how do you now it is a normal situation until it is or isn’t?

It is no consolation to my sister that the baby initiates labor in a “normal situation.”

The Bofa on the Sofa

We are engaging in a thoughtful discussion,

I contend that, no, you have not been thoughtful, but have, instead, been _thoughtless_.

Dr Kitty

Mealy mouthed non-apology it is.

Yup, pretty much what I expected.

Dr Kitty

To add.

Lady, you failed the test.
You were given the chance to be the bigger person, to take something back, to admit when you were wrong and to sincerely apologise for the hurt you caused.

Had you done that, while I may not agree with you, you would have earnt my respect.

Instead you have proven yourself to be exactly as self serving, arrogant and unpleasant as I feared.

Well done- nikkilee, never fails to disappoint.

Sarah

Nice non-apology.

maidmarian555

“If what I’m writing is taken as hurtful”

Is the same as

“I’m sorry you took offence”

That’s not an apology. It puts the blame on the people you’re allegedly apologising to.

nikkilee

Really? You are in a crowd, and accidentally step on someone’s foot. You didn’t intend that at all, if what you were doing hurt someone, you are sorry.

I hope no one takes any of this discussion personally.

Sarah

Fuck me sideways, you honestly don’t understand do you?

Dr Kitty

Keep digging- that hole you’re standing in can only get bigger.

Who?

Do you talk to your clients this way?

Of course. You need them emotionally dependent, you need to make them believe only you know what’s best for them.

And what’s best for them? Anything that lines your pockets.

The Bofa on the Sofa

If you are jumping around carelessly with heavy soled shoes, and stomp on someone’s foot, saying sorry doesn’t mean much. In that case, the injury is a direct result of your choice to act carelessly.

We do this with our kids all the time. They get crazy and we tell them they need to settle down before someone gets hurt. One of them doesn’t settle down and hurts the other. Sorry, I didn’t mean to!

Yes, you did because you chose to continue to act recklessly after being warned against it.

And don’t you tell me not to take it personally. I have told it, it is my nephew who you are accusing of not knowing when to be born. You are talking about real babies and real people. This is not a game, you ass. These are people’s lives we are talking about. You goddamn right it’s personal, no matter how passive-aggressive you try to be.

maidmarian555

I really don’t think that making statements that you’ve been told are cruel and hurtful to the friends and families of loss parents is at all comparable to stepping on somebody’s foot in a crowded market….

nikkilee

No they are not. And I am sorry.

The Bofa on the Sofa

And the next question is, do you mean it? For example, has this led you to reconsider your belief that “babies are born when they are ready”? Or will you pull that out the next time a client is considering an induction?

That’s how we will know you are really sorry.

Azuran

There’s really nothing thoughtful about this discussion. One one side, you are basically trying to agree with us on everything (Saying that medical decision should be made between a women and her doctor, that proper monitoring and intervention leads to better outcome, that formula is totally ok.) But that everything above is wrong and you get money from women to tell them their Doctor is lying to them because ‘golf game’ that induction and c-section are bad, that breast is best all because that’s what they want to hear.

You are nothing but a joke and an hypocrite.

fiftyfifty1

“In the normal situation, the baby seems to be the one to initiate labor. ”

No, timing of labor is actually a complex interplay between fetal AND placental AND maternal factors. Maternal factors are probably every bit as important as fetal factors, that’s why the tendency to give birth prematurely or postmaturely clusters in families and ethnic groups.

About 20% of labors don’t start at a healthy time if left up to nature.

momofone

For someone whose “intention is to learn,” you certainly don’t listen.

Dr Kitty

But IN THE REAL WORLD those few days don’t actually matter, do they?

The baby who was destined to be born at 40+3 but is induced at 39+4 won’t ACTUALLY suffer any serious adverse outcomes related to the timing of delivery, will they?

nikkilee

Probably not; the baby will go home with mom. But how can we really know?

Dr Kitty

Really?
REALLY?

That is the best you can do?

Fear, Uncertainty and Doubt, without a single shred of evidence.

Madam, you should be ashamed of yourself.

fiftyfifty1

“Fear, Uncertainty and Doubt, without a single shred of evidence.”

That’s how she makes her living. She peddles the doubt and then sells the “solution”.

Amazed

We know, liar. We know. We, as in you included. I know it’s your income you’re defending but really, even you should know when you’re way past being absurd. What do you think perinatal mortality means, nikkilee, and why is it so great in the USA if your doubts are so grounded in reality?

Azuran

If anything, science actually say that the baby that is induced at 39+4 as a HIGHER chance of going home with mom than the one born naturally at 40+3.
We have showed you proof of this and you have actually agreed with it. So why are you still trying to defend that it’s better to let labour start naturally?

moto_librarian

Yup. No doubt about it. You’re a bad person.

Azuran

Oh yea, I’m sure my colleague’s baby was totally ‘ready’ to be born at 28 weeks. (Her labour started 100% naturally, at 28 weeks.)
Babies don’t freaking know when to be born. Didn’t you say you are a nurse?, because you really do believe is some stupid shit.

Dr Kitty

I’ve just heard that one of our friends has lost one of their twins after going into labour at 25 weeks, the other is fighting hard but it’s touch and go.

Yep. This needs a response. I know this is the type of situation where she is going to want to run and hide, and respond with her typical crickets, but no. That is not acceptable. She needs to actually respond.

(HINT: the best option would be an apology; anything else would not be wise; and, as we tell our kids, apologies mean nothing without a change in the behavior that led to the problem in the first place)

nikkilee

Most babies do. Some babies don’t. This is the reason for prenatal care, so that intervention can be used when necessary.

Azuran

No. Birth is a biological process that is uncertain, full of variable and prone to failure like any other biological process.
Babies don’t known when to be born. Birth isn’t started by some will of the baby. Babies don’t even have any kind of notion of birth.

nikkilee

Not a choice. It is a physiologic readiness. Here’s how one source explains it:

“During late pregnancy, the uterus has an increased number of immune cells (macrophages). Macrophages help fight lung infection by effectively sweeping up any viruses or bacteria that might be present. A protein found in lung surfactant actives the macrophages, which begin to migrate to the uterus wall. Once there, a chemical reaction takes place, stimulating an inflammatory response in the uterus that begins the process of labour. The surfactant protein is called surfactant protein A (SP-A). Babies begin producing SP-A at around 32 weeks and levels increase for the remainder of the pregnancy, until the lungs are mature enough to breathe outside the uterus. Researchers looking at what signals labor to begin, found that pregnant mice would deliver early if they were injected with SP-A. When pregnant mice were given an antibody that blocked the production of SP-A, the mice would gestate for longer than usual. This research could indicate why some women go into labour spontaneously at 42 weeks or after, because the production of SP-A happens later than other women who give birth at 38 weeks.”

Oh don’t go linking to research you don’t understand again. The bottom line is that a large percentage of pregnancies do not go into spontaneous labor at a safe time. Labor *naturally and frequently* starts too early for the baby (i.e. prematurity), or too late for the baby (causing mec aspiration, macrosomia, stillbirth), or too late for the mother (resulting in injury or death due to fetal macrosomia, or death due to complications of eclampsia etc.)

We know that the mechanisms that start labor are frequently faulty, and we KNOW from research that outcomes IMPROVE for both mother AND fetus with ROUTINE induction of birth at term.

The Bofa on the Sofa

The bottom line is that a large percentage of pregnancies do not go into spontaneous labor at a safe time.

Heck, I don’t even know if it is “large percentage,” It is, however, “too many” that do, and with babies, there is no messing around with safety.

At least for not for normal people. Monsters, otoh…

fiftyfifty1

Well, in the US, ~12% of babies are premature. It’s even higher if the mother is of African or Filipino ethnicity. About 5% of pregnancies will go past 42 weeks if left to nature (and that’s 42 weeks based on good accurate dating). But increased risk of stillbirth and mec aspiration starts well before 42 weeks. So at least 1 in 6 babies apparently doesn’t “know when to be born”. That’s sounds like a large percentage to me.

Azuran

So stop saying that babies know when to be born. It’s not true.

Like I said, biological process starts labour, and those biological process don’t ‘know’ anything. They just are and they respond in a predetermination manner to biophysical changes. There is no will of any kind behind it. And just like ANY biological process, it can, and often do, fail in a significant portion of the time.

Do they ‘generally’ work well? Yea. But that doesn’t mean you should trust them. Would you get on an airline that ‘generally’ doesn’t crash? Buy a car that ‘generally’ start? Put your kid on a horse that is ‘generally’ tame?. No you wouldn’t, and that’s why we do monitoring and pre-natal testing.

Yea sure, women can totally give birth at 42 weeks totally naturally. But some babies will die between 38 and 42 weeks, because no, nature doesn’t ‘know’ when it’s best for any baby to be born.

nikkilee

I agree.

Azuran

So why the fuck have you been arguing all day that babies know when to be born? Or that c-section or induction are bad?

nikkilee

I’ve said that interventions carry risk, and that benefits and risk need to be balanced when making decisions. I’ve not used any subjective words.

The Bofa on the Sofa

Who doesn’t think risks need to be balanced? Doctors and mothers are always balancing risk, including when they choose intervention.

So why do you think you think you are contributing?

nikkilee

I am contributing information from other points of view, based on working (providing care and teaching) in the healthcare system for 40 years, both in hospital and in community. It would be nice if benefits and risks were balanced for every client. But that doesn’t happen in real life. For one thing, visits in a physician’s office are, in my region, scheduled at 15-minute intervals. How can there be time for the thorough discussion necessary at a visit where one is with the physician for 13-16 minutes, in addition to the discussion? How can many women have those conversations when she sees a different provider at each prenatal visit, and then has a different provider, a laborist, catch the baby when she comes to the hospital? This is a systems issue.

The Bofa on the Sofa

So your response is to mislead patients?

In fact, if women want to know this information, the answer is easy: ask your provider.

I have never known a provider who didn’t take the time to discuss issues that the patient wanted discussed, even in the 13 – 16 minute appointments. We had short scheduled appointments, but were never left without our questions answered.

The doctor says, “I recommend an induction”
The patient can respond in many ways, including, “What are the risks of that?” and the doctor will talk about it. Or the patient will say, “OK” where the doctor won’t.

You are bemoaning the fact that women will agree to inductions without hearing your list of warning signs. However, they could if they wanted that, they could easily ask. The fact they aren’t tells you they aren’t all that interested. They trust their doctor, and for good reasons.

You are trying to sabotage that trust, for your own benefit. And lying to do so.

nikkilee

Not misleading at all. Different to what you are saying.

The Bofa on the Sofa

Do you peddle the nonsense that “babies know when to be born”?

Nick Sanders

According to my mother, I was so overdue that my skin was peeling. But then, to this day, I still prefer staying in to going out 95% of the time, so who knows?

Heidi

Sooooo, you think it’s a bad thing a woman has a different doctor every visit, yet you’ve been claiming interventions are used for doctor’s convenience? I explained to you how having multiple doctors ensured my doctors would not intervene out of of convenience. They worked in 12 hour shifts on labor and delivery. When their 12 hours was up, they got to go home and get sleep! I think it’s great. It was also great that they had each other to discuss pros and cons of my care and whether an induction should take place and when it should take place. I felt better in knowing that if my labor took a while, I was going to be given a well-rested doctor who knew in 12 hours, he or she got to go home.

Azuran

So you want women to have the same Doctor during their delivery as the one they saw during the pregnancy.
But you can’t realistically expect all doctors to be available 24/7/365 days. And then stay through a 48h labour. And what if another one of their patient starts labour after the first one is finally done? That could mean that doctors can’t leave a hospital for days. You want a doctor that has been up for 3-4 days to take care of your birth?
That’s the kind of thing that would definitely cause doctors to push for induction and c-section. All those ‘convenience’ things you hate so much.
Do you even logic?

Heidi

I asked her why she wasn’t advocating for a different model for doctors if she truly thinks doctors do c-sections and inductions out of convenience and I got cricketed.

Azuran

Oh at this point it’s obvious that she’s just anti-Doctor for no valid reason and that she complains about stuff she neither understand nor has any alternative plan for.

Dr Kitty

I have a feeling nikkilee would prefer midwifery led care and 30 minute appointments.

Which is useless for people like me.
I don’t have a lot to discuss with midwives.

What I wanted at each appointment was a growth scan (as I’m perfectly capable of dipping my own urine, measuring my BP and my SFH, and did) and a date set for CS as early as possible.
I can also palpate my own abdomen for lie and I have a Doppler on my desk.
Community midwife appointments were not useful, other than the reassurance that not wanting a VBAC was fine and the advice to “get up the road like a rocket” if I suspected labour had started.

What ended up happening with my second was my OB literally shouting down the phone at the theatre sister at my 37w appointment so that I had my CS booked for 39w0d instead of 39w4d. The theatre sister insisted that 39w0d wasn’t feasible because the list was almost fully booked1 the OB basically wore her down until it suddenly was.

Another OB ended up delivering my son… which was fine, I wanted the date more than I wanted that OB and the one I got was lovely.

Individualised care means just that.
Not everyone cares who they see or wants to spend 30 minutes talking.

Psst also, Nikkilee, I provide antenatal care with 10 minute appointments- guess what, if I run late because I have to spend longer with that patient, I just run late!!

moto_librarian

She wouldn’t care for my CNMs then. My appointments were rarely more than 15 minutes.

Empress of the Iguana People

Yeah, my doc too. Sometimes I was in and out, other times it was a little longer. The last several, Dr E spent more time checking my emotional state than my physical one.

nikkilee

Is logic a verb? No, doctors can’t be available every day. They get sick, take vacations, and have days off. That is understandable and coverage has been part of practice for decades. However, many of my clients see a different doctor every visit, and don’t know the person who be there are the delivery. I don’t know of anyone who likes this. I don’t want it. I want relationship with my provider; as a provider myself, I enjoy getting to know people.

Heidi

Well, there you go assuming what you want is what everyone wants. I’ve told you on more than one occasion I liked having more than one OB/GYN! I don’t give a flying **** about getting to know the personal details of my OBs’ lives. I had multiple doctors evaluating my care meaning there were checks and balances, no doctor was overworked, and I got appointments in a timely manner when something came up during the end of my pregnancy when I needed to go twice a week.

That aside, though, how would you suggest we have a woman have one personal doctor yet have a doctor available for her labor but also eliminate overworking a doctor tempting them to intervene unnecessarily? One person, which is what you’re proposing, can’t be everywhere all the time. You’ve never provided an even close to workable solution.

Azuran

Do you even _____ is a meme.
Also, I’m followed in a gynecology clinic. They have 13 OB/Gyn, I haven’t seen the same doctor twice so far and when I’ll give birth it will be one of those 13 doctors (and probably more then one depending on the length of my labour) and possibly one that I haven’t seen.
I don’t care, I love the clinic, they give awesome professional services, they are the best around. Maybe you should stop assuming that what you want is what everybody wants.
Do you have a different option? Because it appears to me that you are once again complaining about things without having any back up plan.
You CANT have every single women see the same doctor for all of their visits. You CANT make them all have their doctor for their birth, whenever it happens and no matter how long it happens. That’s real life, at some point, people have to deal with the reality.

fiftyfifty1

You know a lot of interventions don’t need a long, long discussion. Take induction at term: “Studies show that induction, with or without a ripe cervix, leads to decreased CS and improved fetal outcomes. Nobody can promise anybody they will deliver vaginally, but an induction does increase your chances. Also inductions prevent stillbirth. Therefore I recommend we schedule you. What questions do you have?”

moto_librarian

My time is valuable. Even during my first pregnancy, I didn’t want a lot of hand-holding. A 15 minute appointment was typical with my CNMs, and given that I work, was appreciated by me. Do your doctors not communicate with each other via charting? I wanted to meet all of the midwives, knowing that whoever happened to be on call would be delivering my baby. Are you saying that the OBs that you work with don’t do prenatal care? That they only “catch” the babies?

nikkilee

Some hospitals in our area use laborists. Their clients get prenatal care from OBs; their babies are caught by laborists.

Dr Kitty

When one of the risks you cite for inductions is “who can really say what damage it will do when a baby doesn’t chose their birthday?” there is a problem.

The Bofa on the Sofa

Ack!

Seriously, what are the real risks of induction?
1) It may not work (after my sister lost her first, they weren’t messing around with her second, so they induced at maybe 39 weeks. I clearly remember her husband calling about 9:30 pm how things were progressing well, and all indications is that by morning, they would have a baby. In fact, everything stalled like immediately, and she was sent home at midnight. She had a c-section 2 days later.
2) ? Oh, I know, it is the “cascade of interventions” and it MIGHT lead to a c-section. But is the c-section caused by the induction? Or does the induction mean that the c-section is done at that point, instead of later? And, of course, there are fewer c-sections with inductions, which suggests that the c-section was probably going to be needed anyway, just at a later time.

Real risks of induction? Not the crap that nikki peddles.

Azuran

Except that you think that everything that happens after an induction is the fault of the induction.

You bemoan that it can ‘lead’ to a c-section. But ALL births can lead to a c-section. And those who are induced have a lower risk of them, but apparently, in all your ‘research’ you somehow didn’t know that.

You also believe that immaturity is a ‘risk’ of induction and c-section, because you don’t have the medical competence to understand that prematurity is a consequences of whatever health problem made the induction/c-section necessary.

You’d probably say that my brother’s very long birth and birth injury (2 broken clavicles) where the result of induction. And not due to the fact that he was post date, macrosomic and that my mom was a primip. And if they had waited for induction, he would have been even bigger.
Or that my cousin being born almost dead was caused also by his induction. And now because he was at 43 weeks with a severely failing placenta.

Empress of the Iguana People

My mother had 3 stillborn daughters, all close to term. I guess my sisters weren’t as good at knowing as my preemie self

Amazed

And your definition of “necessary” is ‘when someone is literally dying”. Charming!

maidmarian555

If we’d have waited for my son to be ‘ready’, he would have died. Me too probably. And even if I hadn’t died, it would have ended in surgery regardless. You seriously need to rethink your life.

The Bofa on the Sofa

I’ve already tried a Jedi-mind trick to get her to go out and sell Death Sticks.

maidmarian555

Selling cigarettes would definitely be less harmful than the crap she is currently trying to flog.

Heidi

Yep, almost no one believes cigarettes aren’t unhealthy. There’s a label on them telling you they are bad. NL doesn’t come with a label and she explicitly sells her services as healthy when in fact she is a dangerous person. She also has no problem tacking RN to her name which IMO should be illegal when it comes to her homeopathy/baby twisting/anti-vaxxer bullcrap.

nikkilee

How is a statement about risks taken to mean that no one should ever have interventions? Interventions are lifesaving, when needed. I dislike the routine use of interventions.

maidmarian555

“As it is the baby who starts labour, when it is ready, a baby can be premature by a matter of days. Gestation is not like a train schedule” was the comment I responded to in this instance. So where exactly was the discussion of risks in that statement? Whilst you may use this technique of twisting your words in RL, it doesn’t work so well online where everything is written down…..

Amazed

But following your appaling logic, relying on the baby’s wisdom can lead to terrible train-wrecks.

Listen, nikkilee, we both know you’re talking bullshit. We both know that as bitter the tears you weep over those poor babies whose knowledge was not followed, they usually make it out alive and undamaged. We both know that once the baby err in their, err, assesment of their timing, they end up dead or damaged in an appalling rate.

You can wax philisophical hypotheticals as long as you want to but that’s the real, phycical thing. Can you not look beyond your personal gain, just this once?

nikkilee

What have I to gain? I’ve had my babies. The whole topic of birth and infant feeding is complex; there is never only one way that will serve everyone.

maidmarian555

You make money from selling childbirth and lactation services. Money would be considered a gain, no?

nikkilee

We are all entitled to make a living. Folks don’t have to use my services; those who do have chosen me because they like what I offer.

fiftyfifty1

“We are all entitled to make a living. Folks don’t have to use my services; those who do have chosen me because they like what I offer.”

The point of the response is to illustrate that “We are entitled to make a living” says nothing about the ethics of that living. You can make a living ethically, or you can do it unethically. Means nothing.

Azuran

Except that surgeon, dentist and lawyers have professional orders and very strict rules over the kind of service they can offer, and the kind of information they give.
They don’t offer false advice or treatment because that’s what their client wants. If they did, they would lose their right to practice.

fiftyfifty1

Arborists, mechanics, dentists and lawyers provide valuable services for the citizens of our country….quacks like yourself, not so much.

The Bofa on the Sofa

Even if we concede the argument that you are entitled to make a living, why did you respond with “what do I have to gain?”

You knew damn well what you have to gain by it, and you pretended like you didn’t? You are a liar.

Azuran

That’s the kind of thing that a faith healer says.
You are selling lies, that’s the difference. Lies that can cause death and permanent injury. Don’t you have any ethics?

Azuran

How ethical do you think it would be of me, as a medical professional, to tell client what they want to hear? And then take their money after giving them false and dangerous medical advice? Should I lie to my client about the medical care their pet needs because that’s what they want to hear?

Heidi

Totally missing the point, aren’t you? In my opinion, most of your services should be illegal or come with a huge disclaimer. I think the craniosacral therapy on babies should be illegal. Your quacky lactation advice should have the same label homeopathic remedies have on them. You can do hair lights and even practice as a lactation consultant IF you stick with legitimate practices (such as never going against the advice of a concerned pediatrician and never pushing your lactivists agenda) and keep your mouth shut about most of your opinions (such as your anti-vaxxer ones). I consider your website an extension of your opinions so I personally think the website has to go or you go by a different name if you want to work at a hospital, health Dept., Clinic, etc. But your business thrives on using scare tactics. Anyone who seeks you for your alternative medicine services is doing so because of FUD. It’s a move of desperation that a rational person wouldn’t do.

Sarah

You were still lying when you implied you had nothing to gain.

moto_librarian

By that logic, I should set up shop and start selling my own “natural” ED drug. Who cares if it might kill people – I’m entitled to make a living.

nikkilee

I see that logic. All the more reason for the consumer to be informed, and know all sides of the topic. This is difficult: I don’t have the time to research plumbing so I can accept what my plumber recommends, or what my car mechanic does. Second best is word of mouth: knowing someone and asking who they recommend is useful.

I’ve been waiting for you to admit that about the “classes” you present to nurses. Thank you!

nikkilee

However, there are times where nurses have been mandated to take classes as their hospital is on a BabyFriendly track. It is challenging to reach the hearts of folks who hate being there, and resist. Sometimes I can do that, sometimes I can’t.

momofone

I wonder if that’s because they see that you don’t listen, and that it’s all one-sided with you.

nikkilee

My evaluations are all positive, so I doubt that. I want to hear; hospitals are moving too fast with these changes.

momofone

Of course they are–people almost always go with positive because they want to get out of there and that’s the easiest selection. Your evaluations also come from people who are largely self-selected to hear you.

I’m wondering when you’re going to address the part where you can’t back up what you say; even your own sources don’t say what you think they say.

The Bofa on the Sofa

I don’t care about your evaluations. I’m sure the guy who teaches creationism at Liberty University gets high teaching evaluations, too. That doesn’t mean he is doing a good job of teaching them, because what he is teaching is garbage.

If what you are teaching is garbage, it doesn’t matter how you teach it, it is all bad.

Azuran

XD evaluations? Really? You take those seriously?
My SO teach at college. He ALSO has VERY GOOD evaluation. Students just love him. Despite the fact that it’s his first year teaching and he actually never took a teaching class. And he’s recently had a long talk with his boss about the things he wasn’t doing right and how he should adjust himself to be up to the standard they expect of him. But Judging from his evaluation, he’s the best teacher they have.

I did my fair share of evaluations at university to. You know how me and my friends did it? It went something like: Meh, I like that teacher. so. 5-5-5-5-5-4(just so I don’t put 5 everywhere)5-5-4(and another one just because) And then we got back to our game of cards. And I can assure you that the majority of people did the same.

momofone

I’ve been thinking about this statement–“challenging to reach the hearts of folks who hate being there…”–and I’m thinking that the problem is that if you’re worried about reaching hearts, you aren’t focused on their minds. (That would require not running away from questions and being able to back up what you say, including having a rudimentary understanding of your own sources.) The last thing I want is someone at what is supposed to be an educational meeting to reach for my heart. It convinces me that they have nothing to offer the rational part.

nikkilee

Thanks for the inspiring comment! I have the evidence and LOVE the questions and debates and disagreements. Bottom line is that a hospital nurse has to take care of everyone, no matter their choice about infant feeding, so need the skills to help with both. . Mothers who chose to feed formula are often not getting the attention and support that the mothers are who chose breastfeeding. Nurses have to reach everyone; all new mothers need special attention. Nurses didn’t become nurses because they love drop down menus. We became nurses to take care of people, to connect and form relationship. Nurses are not robots; education without heart leads to mechanical work doesn’t reach the client deeply enough. The 3-step social marketing model developed by Carol Bryant in the 90s is this: 1) elicit concerns, 2) validate feelings and 3) targeted education. Skipping step 2 (feelings that come from the heart) leaves out an essential step. If a mother is worried about her milk supply (a normal fear present in every new mother), then giving her a list of ways of how to know the baby is getting enough doesn’t work. Dr. Jane Heinig showed this in her WIC research; mothers don’t use the poop counts and feeding frequency and weight gain to feel confident that their babies are alright. Humans are creatures of heart and mind; nursing care is the most effective when it reaches both. When a nurses in my class can say, in an accepting environment, how they hate breastfeeding, the door is open to learning. I have too much to say about this to write it all here. . .sorry for the rambling, and you can see that I am passionate about this. . . .and effective, when you look at my class evaluations.

momofone

“I have the evidence and LOVE the questions and debates and disagreements.”

You have yet to back that up here.

nikkilee

1) Few believes any evidence that I’ve shared here, unless it supports a belief they already hold: i.e. that breastfeeding has no benefits in the US.
2) I am still here.

And the recommendations from AAP; ACOG, NAPNPA, ADA, APHA, the WHO and every health agency and organization in the world.

2) I am one, you are collective. I respond to sincere questions, honest challenges, and respectful disagreements; less time available for that now as I have been much more politically active than ever before. One place where Dr. Tuteur and I agree is in our concerns about POTUS.

Azuran

So, when we pointed out that you posted a study about China and breastfeeding that proved exactly the opposite of what you claimed it did. And you refused to address that point for weeks. Was is because you thought it wasn’t a sincere question or because we weren’t honest?

Or again, when you refused multiple time to address my point that using ‘the majority’ as an indicator of anything in medicine isn’t valid.

momofone

I am also one. You are choosing to group people in order to justify your lack of response.

As far as your study, you know exactly which one I’m referring to. You are being disingenuous.

Azuran

Because we have been provided with better evidence that the benefits are trivial. We don’t actually believe that there aren’t any benefits. Just that in the grand scheme of things, when you factor in everything that is going to determine the health of a child, in the US, breastmilk is not very significant.

Evidence isn’t judged on in what order it was presented. Just because you presented evidence last doesn’t mean it’s going to change our mind because it’s the last we’ve seen.
It hasn’t changes our mind because
-We have seen, and debunked, the same biased evidence multiple time in the past
-The quality of the evidence you presented is lower than the quality of evidence showing that breastfeeding isn’t that important.

nikkilee

SIDS and Diabetes and Cancer are not trivial benefits.

The preponderance of evidence overwhelmingly supports the value of breastfeeding and human milk for human infants.

Azuran

Oh sure, you can say those things are not trivial. I didn’t say there where, I said the effect of breastfeeding on those is trivial and can often be achieved with much better success with other means.
You want to prevent SIDS. Well then, I hope you recommend pacifier and vaccination just as strongly as you recommend breastfeeding because they have about an equal effect. I also hope that you strongly discourage bed-sharing, since it greatly raises the risks. Do you also speak to parents about not smoking in the house?
Diabetes, well, putting aside genetics, which you can’t really do nothing about. Do you talk to your clients about the importance of maintaining a healthy diet and make their child exercise on a daily basis trough their childhood to prevent childhood obesity? After all, obesity is a MUCH bigger factor (and the link between breastfeeding and diabetes is really shaky at best)
And cancer, you mean the risk of breast cancer in women? Do you talk with your clients about their family history of breast cancer? Do you talk about genetic testing, mammograms and all those other things that people can do to reduce their risk of cancer?

Oh, and do you educate mothers about the risk of insufficient milk production in the early days of breastfeeding? Do you tell women that delayed milk production can cause dehydratation, hypernatremia and brain damage? Do you explain to them when and how they should supplement to prevent those problems?

nikkilee

The AAP has moved breastfeeding to #3 on their list of recommendations to prevent SIDS, after back to sleep and a firm sleep surface. Next is having baby in the same bedroom, for 1 year if possible. #$ is keep soft objects away from baby’s sleep area. #6 is “consider offering a pacifier at nap time and bedtime” (“For breastfed infants, pacifier introduction should be delayed until breastfeeding is firmly established.40 Infants who are not being directly breastfed can begin pacifier use as soon as desired.”) #7 is Avoid smoke exposure during pregnancy and after birth. #8 is Avoid alcohol and illicit drugs during pregnancy and after birth. #9 is avoid overheating and head covering in infants. #10 is for women to get prenatal care. Then comes vaccinations, avoiding devices sold as SIDS prevention, avoiding use of cariorespiratory monitors as strategy to prevent SIDS, supervised TummyTime for infants, no evidence that swaddling reduces SIDS risk (#15) staff in NICU to model best practices, Safe Sleep campaign to continue.

AAP did revise their recommendations to include this: “The safest place for an infant to sleep is on a separate sleep surface designed for infants close to the parents’ bed. However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep. It is important to note that a large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no pillows, sheets, blankets, or any other items that could obstruct infant breathing or cause overheating should be in the bed. Parents should also follow safe sleep recommendations outlined elsewhere in this statement. Because there is evidence that the risk of bed-sharing is higher with longer duration, if the parent falls asleep while feeding the infant in bed, the infant should be placed back on a separate sleep surface as soon as the parent awakens.”

There are currently 11 different theories as to why formula use triggers diabetes in susceptible populations. Cow protein and soy protein are both triggers. There is cow insulin in cow milk formulas; cow insulin is close enough to human insulin that some babies can develop resistance.

Susceptible populations are those with a genetic history, those who are Scandinavian, African, Latina, Native American or Pacific Islander.

As you say, there are more factors to the global epidemic of type 1 and type 2 diabetes than infant feeding. Infant feeding is a modifiable factor.

Besides breast, ovarian and endometrial cancer in women, the risk is higher in babies not breastfed for lymphomas and leukemias.

Mothers and babies should be seen by the provider 2 or 3 days after hospital discharge; this is repeated throughout the course, in order to pick up those situations early: dehydration, failure to gain weight, and jaundice.

nikkilee

Babies should be seen 2-3 days after hospital discharge to prevent dehydration and jaundice. AAP recommendation.

Breastfeeding reduces maternal risk of breast, endometrial, and ovarian cancer. In children, their risk of lymphomas and leukemias is reduced.

The new AAP recommendations about SIDS are here. Breastfeeding is #3 on the list, after back to sleep and a firm sleep surface. There are many more recommendations.

As for diabetes, there are about 11 different theories as to why formula triggers diabetes in susceptible populations. Currently there is a 10-year study going on, the TRIGR study, so industry can figure out how to reduce diabetes risk when formula is used. Maybe a different type of formula will work? That’s their main hypothesis. While there are many factors that trigger diabetes, infant feeding is a modifiable factor.

Azuran

And you think it’s fine for a baby to go 2-3 days without freaking food? You are going crazy about women who can’t eat during labour. But not feeding a newborn for 2-3 days is ok in your book?
Cancer: By how much? And really, how does telling a woman ‘but it reduces cancer’ helps her to actually breastfeed? It doesn’t. It just put stress on those who are struggling and causes shame in those who decide not to.
Diabetes: Again, how much of a diminution? If we have 11 ‘theories’ that pretty much means that we have no freaking clue. And again, you are just making people feel bad.

And yes, that’s till pretty much trivial. My mom is diabetic because she is obese and her dad is also obese and diabetic. If I ever end up with diabetes, it’s going to be because I have a huge family predisposition to diabetes, not because I was formula fed.

Sarah

That’s because you keep posting evidence that doesn’t say what you want it to. That would be a failing with you and sometimes with the things you cite, not us.

momofone

“When a nurses in my class can say, in an accepting environment, how they hate breastfeeding, the door is open to learning.”

Learning on whose part? Yours, in terms of finding out why, or “learning” in terms of an opportunity for you to try to convince the nurse otherwise?

nikkilee

1) Those nurses have to take care of all mothers, no matter what is the mother’s feeding choice. So they have to learn something about how to work with a mom who is breastfeeding, and have an obligation to give best care. 2) Nurses can feel that way for a variety of reasons: a sad personal story, lack of time to give the best care (hospitals are notoriously understaffed), resistance to changing policy (no one likes change), a lack of understanding, to name but a few. There are always reasons; once the story is revealed, then the real work can start.

momofone

Whose or what “story”?

nikkilee

The one behind a nurse hating breastfeeding.

momofone

Does it matter in terms of how s/he cares for her/his patients?

nikkilee

Yes. It is difficult to be an effective teacher if you dislike what you are teaching about.

The Bofa on the Sofa

It’s even harder to be a good teacher when you are clueless about what you are trying to teach, but that never seems to stop you, apparently.

nikkilee

Statistical evaluations show both satisfaction with the course, improvements in self-assessed abilities, and increase in learning, as presented at a CityMatch conference last year.

momofone

Only if by “teaching” you actually mean convincing someone to do something they don’t want to do.

nikkilee

No. That is not what I mean at all. Information can be presented in a way that is either positive, or neutral or negating.

Box of Salt

This goes both ways, nikkilee.

Dr Kitty

But you ARE getting money from clients who pay for your “advice” about the management of pregnancy, childbirth and lactaction, aren’t you?

Or is it another nikkilee who’s running a dangerous website and is also a quack?

Box of Salt

nikkilee “The whole topic of birth and infant feeding is complex; there is never only one way that will serve everyone.”

Ding ding ding! This is why you need to stop demonizing feeding formula.

Your ability to speak out of both sides of your mouth is astounding. Are you sure your tongue is not forked?

fiftyfifty1

“As it is the baby who starts labor, when it is ready”

Tell that to all the babies who die as preemies after premature labor.

momofone

Oh ok. So my friend’s twins started their labor at 22 weeks because they were ready? I’m sure that will be a great comfort as she and her husband deal with the multitude of issues related to extreme prematurity. Hey, at least they were ready, though, right?

nikkilee

In the healthy normal situation, it seems to be the baby that triggers later. 22 weeks doesn’t fit that category.

fiftyfifty1

“In the healthy normal situation, it seems to be the baby that triggers later.”

Why do you keep lying? You’ve had this explained to you in detail before.The timing of labor is a based on a *combination* of maternal, fetal, placental and environmental factors. It’s a complex system, and it’s a system prone to errors, unfortunately. When NCB advocates like yourself tell women that labor happens “because the baby is ready” and that if it hasn’t happened it’s “because the baby isn’t ready”, it’s a deadly lie.

momofone

It’s interesting to me that yet again, you choose to respond to this, leaving unanswered many other questions that have been waiting for you for weeks, including several related to the study you posted that didn’t say what you said it did. Are you now willing to address that?

nikkilee

Not premature to be in the NICU. But earlier than that baby and mother and placenta were ready to be engaged. . . assuming that everything else is healthy and perfect.

GBS sepsis
Hypoxic ischaemic encephalopathy
Meconium aspiration syndrome
Chorioamnionitis from PROM leading to sepsis
Uterine rupture and placental abruption leading to death or disability from hypoxia and hypovolaemia.

Yes, there is risk to having a baby. The risks are greater, given that mother and baby are healthy, with surgery. Some consequences can come from mismanagement of labor. Episiotomy increases the risk of tearing. When mothers are lying on their backs, or sitting on their sacrums (which then can’t move out of the way), their babies have a more difficult time being born. Epidurals can take away some pushing sensations, so that mothers push harder than necessary, increasing other consequences (piles and pelvic floor issues). Nausea and vomiting can come as a part of cervical opening. Infection from PROM can sometimes come from vaginal exams. There are so many different ways of looking at birth. Here’s a collection of birth films made at Tobey Hospital, in Wareham, Massachusetts. (Please ignore the 70s soundtrack). https://www.youtube.com/watch?v=J8dTjNSbv9M

Dr Kitty

Nikkilee, no one is arguing that an uncomplicated spontaneous vaginal delivery after a quick,easy labour with an intact perineum isn’t an optimum outcome for women who want to have a vaginal delivery.

But it isn’t an outcome that every woman will get.

The current rate of instrumental deliveries as a proportion of all deliveries in the U.K. Is around 17%, for one thing.

The rate of epidural use in the U.K. Is lower too. The last two of my patients with third grade perineal tears had laboured with midwives and only Entonox for analgesia and had to have repairs in theatre with spinals. Neither had episiotomies or instrumental deliveries.

You cannot present best case scenarios as typical for VB and worst case for CS, you actually have to present all the outcomes.

You should clarify that by “breathing difficulties” you mean TTN- which is transient, without long term sequalae.
Unlike, for example, OBPI or HIE.

As for the babies that are cut during delivery- the vast majority it’s a tiny nick that is easily repaired with surgical glue and doesn’t even scar.
Unlike a fractured skull or clavicle which will leave lifelong radiological evidence of trauma.

Both papers list factors contributing to PPHN, one of those factors is elective cesarean section.

Birth is risky; the chances of risk are higher after surgery. And surgery is sometimes needed. What we are each saying is true.

Dr Kitty

You still haven’t actually come out and said that you support MRCS in the absence of medical indications.

Want to do that now?

Dr Kitty

The incidence of Persistent Pulmonary Hypertension of the Newborn, should anyone be curious, is 1.9 in 1000 live births.

Of which only a minority could possibly be caused by elective CS alone.

BeatriceC

All three of my living children were preemies. Exactly one has any long term consequences due to their births. Wanna guess which one?

1. 36 weeks, VB
2. 32 weeks, CS
3. 24 weeks, CS.

Did you guess number three? Nope. He’s perfectly normal once you eliminate medical issues caused by an unrelated bone disease.

The answer is number 1. My oldest has a lifelong disability on account of the shoulder dystocia during his vaginal delivery. He has intermittent paralysis episodes in his dominant arm which often time occur with no warning and can last anywhere from a few seconds to a couple hours. He’s medically contraindicated from ever getting a driver’s license. This could have been avoided with a CS, but since it wasn’t, the kid has to live with it.

moto_librarian

Uncontrollable pushing can also cause severe tears, including cervical lacerations. My unmedicated delivery is what did the damage to my pelvic floor.

Azuran

I like how you put Prematurity in there. As if babies where suddently becoming premature BECAUSE of the c-section­.
The prematurity is a consequence of the REASON for the c-section. Not a consequence or a risk of the c-section itself.

Sarah

Not in that rather poor article you felt the need to share they’re not.

And yet again nikkilee, literally NOBODY is saying sections don’t have risks. You are savaging a strawman of your own construction there. They are saying that there are also risks to vaginal birth too. If you want to argue that sections are less safe, you need to have a way of weighing up these risks against each other.

You conspicuously fail, yet again, to do this. Unless and until you do, you might as well just be farting out of your mouth.

Daleth

The risks to mother and baby of vaginal birth are also well documented.

FOR THE BABY (please compare this list to your list of c-section risks to babies, and let me know which risks you think are more serious–btw that’s a rhetorical question):
DEATH (usually due to oxygen deprivation, occasionally due to forceps accidents);
BRAIN DAMAGE
Permanent partial PARALYSIS (brachial plexus palsy)
A broken clavicle (a common complication of having to yank the baby out to save its life when shoulder dystocia happens)
BRAIN BLEEDS (from the use of forceps or ventouse/vacuum extraction)
Other disabling injuries due to forceps or vacuum (my mother was permanently disabled by forceps misuse at her own birth).

FOR THE MOM
Fecal incontinence (an automatic and inevitable complication of a fourth-degree tear);
Loss of sexual sensation due to nerve damage;
Urinary incontinence (a complication of pregnancy itself, but statistically more severe and lasting in women who delivered vaginally);
Prolapse (i.e. your uterus and/or bladder droop down and may even literally fall partway out of your body);
A need for major surgery, possibly multiple times, to even *attempt* to repair the incontinence and prolapse.

Let’s at least be honest with women that there are pros and cons to both methods of giving birth.

Roadstergal

Hemorrhage is a risk to mom in VB, too? Also, ironically for the NCBers, retained placenta, which can affect milk coming in?

Daleth

Right, thanks for pointing that out. Both hemorrhage and retained placenta can mess with lactation. My hemorrhage is probably why literally only one of my boobs worked (produced more than a negligeable amount of milk).

corblimeybot

Really, huh, I had a blood transfusion after a vaginal birth because I lost so much blood I couldn’t lift my head and was seeing things. Must have had a c-section without realizing it.

Oops, no, definitely didn’t have a c-section because my kid had a severe shoulder dystocia.

Who?

I had fierce constipation after each of my natural, unmedicated deliveries. And no I wasn’t taking codeine.

Dr Kitty

Codeine- a constipating agent with mild analgesic properties, as my pharmacology Prof used to say.

fiftyfifty1

And in ultrafast metabolizers, a respiratory depressant at normal doses!

Dr Kitty

And in non metabolisers, a placebo!

Codeine- does everything or nothing depending on your genes.

Who?

I actually love codeine, it makes me all limp and I don’t know if there’s no pain or I just don’t care about it.

The constipation is real, though…

corblimeybot

Yeah, what is she even talking about with constipation? I was in a moms group in which every one of us had constipation after our deliveries. The members’ deliveries ranged from emergency c-section to the most nikkilee-approved, woo-infested homebirth imaginable. None of us could crap after birth.

Heidi

Pregnancy itself was generally a constipation fest. After birth, the good ol’ vaginal kind with a fairly small 6 lb 5 oz baby, I was too scared to poop – definitely not scared shitless though!

Sarah

Snort. I crapped beautifully after both of mine, instrumental and section. Conclusion= natural delivery makes you constipated. Well, it’s no less scientific than nikkilee…

Empress of the Iguana People

I actually was a bit constipated after my kids’ births. Had ’em by the more common method

Erin

I was mostly midwife led in my first pregnancy. They lied, withheld information and were at least partly culpable for my suicide attempt. They didn’t prevent me from needing a section, they just ensured that every single eventuality had been exhausted before I was allowed one, half killing me and endangering my son in the process. No one asked what I wanted (a healthy baby and not to be lied to), it was all about process. Luckily, I suck at killing myself as much as I do at giving birth and my son survived his ordeal absolutely fine but it was a close run thing and that to me is unacceptable.

In an attempt to cut section rates our local hospital is now trying to claim that one prior section isn’t reason enough to get another unless you have another medical issue. I’m a supporter of vbac for those who want it, I find being forced into it horrendous.

maidmarian555

Yeah that really worries me too. I would really like another baby. I know the NICE guidelines state that any woman requesting a c-section should be allowed one but after my previous experience, I’ve been left really mistrustful of midwife-led care and suspicious that I could find that request ignored. Luckily for me, I live near several large hospitals with labour wards. If one of them said no, I could potentially go to another. That is assuming that the community midwife didn’t try and get in the way of that though. Mind you, after last time I absolutely wouldn’t accept anything without making an enormous fuss. I refuse to be bullied by them again.

They’ve really started pushing home births here too, one of my pregnant friends was told she should have a home birth kit in her house ‘just in case her labour was too fast to get to hospital’. From what I gather, she politely told the midwife to eff off but I thought it was a bit alarming that it sounded like they were trying to push women into home births via stealth tactics (nothing would surprise me).

Dr Kitty

I’d have the NICE guidance as well as the Supreme Court ruling Lanarkshire vs Montgomery printed out, highlighted and stapled to my notes.

Ask to record any conversation where it looks as if your autonomy is not being respected or national guidance is not being adhered to.

Explain that you aren more than happy to complain to department heads, CEO of the Trust and relevant regulatory bodies if your autonomy is not respected.

Dr Kitty

If my Trust were trying to pull a ” no ERCS without a medical indcationnpreventing attempted VBAC” I would write a formal letter to the Trust CEO

In it I would state that I am concerned that their new VBAC policy is not evidence based and is not taking into account the wants and needs of individual women, to the point where I would no longer feel confident that your desire to have an ERCS would be respected.

Ask for them to put their policy, along with their evidence basis and any justification for ignoring national guidance and the Supreme Court decision on informed consent, in writing.

I guarantee you that the Trust will reply and put in writing that *of course* your autonomy would be respected and that VBAC isn’t being forced on women against their wishes.

I would then proceed to wave that letter under the nose of anyone who suggests that TOL is mandatory.

maidmarian555

Thank-you for your advice. I’ve saved your comments in case I ever need to go down that road. We’re not quite at baby #2 yet (particularly after #1 just sneezed an entire mouthful of spaghetti bolognaise in my face).

Dr Kitty

Delightful!
My toddler likes giving “kisses” that are basically “licks”.
That and the fact he has worked out how to take off his nappy this weekend are testing my tolerance for germs.

maidmarian555

My OH is an enormous germophobe and neat freak. Having a baby has definitely tested his limits. Luckily (for him) wee man seems to save his most delightful moments especially for me. I am not sure how well he is going to cope with the toddler years and when he inevitably works out how to undo his nappy without our help! (I should add that he is a brilliant Dad and has been more than willing to put aside his fear of germs and deal with our disgusting poo-machine baby on many occasions. I have found him over the sink scrubbing his hands in a slightly over-enthusiastic manner afterwards on more than one occasion though).

Dr Kitty

Erin, how are you doing at the moment?
Have you got your birth plan agreed in writing (and signed and dated by your lead clinician)?

I hope you’re not too stressed counting down the days, and that this pregnancy isn’t too painful or tiring.

Erin

I’m one of the “lucky” ones who bloom whilst pregnant. Morning sickness wasn’t as bad this time either so the pregnant bit is fine.

I’m seeing another Clinical Psychologist with extra support from my Psychiatrist and that’s helping a bit. Odds of me having major meltdown have decreased quite a bit, in fact I might not be the hysterical woman in the car park after all.

Birth plan (not convinced it’s worth the paper it’s written on) has been signed off on. It’s still general anesthetic however they’ve made a point of stressing to me I can change my mind at any point until it’s administered. Got an appointment coming up with my psychologist and an anesthetist to discuss what they could do to make it better if I decided I wanted a spinal. Told them it’s a waste of time but agreed to go because there is little tiny kernel of me that wants to be awake.

Only issue is labouring before hand as I’ve been pretty much told that whilst they’ll take my mental health issues on board, given that I’m sickeningly healthy, they can not guarantee that I can walk into the hospital in labour and immediately get a section unless there is another problem, especially if it’s a night/weekends as they will prioritise the mother/babies who aren’t sickeningly healthy. Scan for scan this baby also has a smaller head and has a posterior placenta. Whilst I can completely understand where they are coming from, the thought of being in labour for hours without proper pain relief (can’t have a epidural unless I’m okay with being awake for a section) waiting for something to go wrong is terrifying.

On the plus side I have a far better support network this time from both medical professionals and friends including two midwife friends and a NICU nurse who work at the hospital and are going to come visit to make sure I’m okay. Both the Psychiatrist and Psychologist love babies and are happy to do hospital visits and I got a chest freezer for Christmas which I’m going to fill with meals.

Dr Kitty

I’m glad that things seem to be about as good as they could be.

If, G-d forbid, you do go into labour, the epidural may seem like a better option than waiting for an empty theatre that doesn’t happen and a subsequent unmedicated vaginal delivery- but of course that will be your call to make at the time.

Best wishes, as ever, and I hope your plan goes off without a hitch. It’s always so satisfying to prep a big batch of freezer food and know that your meals are sorted for weeks!

Erin

I went into labour with baby 1 at 38 plus 4 and I keep being told (mostly by midwives) that I’m more than likely to go before the section date (currently 39+ 3 due to the way the weekend falls) because of that and my “advanced maternal age”.

In every other aspect, they keep saying “different baby, different labour” but when it comes to timing… apparently it’s the same. Is there any truth in that?

Empress of the Iguana People

i think so, my ob said 2nds often come a little earlier than firsts

Dr Kitty

Some truth, but each pregnancy genuinely is different.
Basically you just have to avoid all the things they tell women to do to bring on labour and hope for the best.
Was it really not possible to bring you in on the Friday? Boo.

Guest

For what it’s worth, my first was at 38+3, my second was induced at 39+5. My sister’s first was 39 something and second was in the 41s.

Mishimoo

If it helps any, mine went: 3 days over, 5 days under*, 2 days over. So here’s definitely a chance you might go to 39+3, and I really hope you make it to your section without any twinges or extra stress/danger for you or bub.

(* every time I mention her birth, I’m grateful that she arrived a few days early because her placenta was crunchy from calcifications and who knows what might have happened if she had stayed in longer.)

Oh wow, your poor parents. That would have been awful! (Not to mention terrifying each time your mum was pregnant)

Empress of the Iguana People

Probably, but they kept that pain from us as much as possible

fiftyfifty1

“Luckily, I suck at killing myself ”

LOL. Yes, being bad at things that are bad for us is a type of good luck, isn’t it? Maybe not such a lovely luck as excelling at things that are good for us, but one has to take luck where one finds it.

Erin

Looking back, it’s definitely lucky just took a while to see it. Just had a lovely day which ended with my son who is obsessed with hoovers describing the merits of his baby Dyson to the Bump with much arm waving and sound effects. Our floors have never been so clean. Although having to seat the baby Dyson at the table in order to get him to stop hoovering and eat was both annoying and adorable.

maidmarian555

I have four prior attempts under my belt. I am so glad I was unsuccessful. And I have no shame about where I was mentally at the time, it wasn’t my fault. I am greatful every day for my life now with my OH and my son. Idk if it helps but I find your story inspirational. I hope all works out very well with #2 for you.

Dr Kitty

OMG!
Super adorable.
Be grateful it is a baby Dyson.

Have you heard of the fresh hell that is Toot-Toot Drivers?
One of the grannies thought #2 would enjoy them.
He does.
The rest of us are going quietly insane now that he has discovered how to trigger them outside their tracks.
My advice is to stick with the quiet wooden train sets.

Erin

The Toot Toot drivers arrived at Christmas. I told everyone that we didn’t want plastic or noisy toys. We got the Toot Toot driver racetrack, two music kits including drums and lots of shaky rattly things and a train whistle in the shape of a snowman which makes the most piercing horrendous noise I’ve ever heard (confiscated in case it sends me into labour…having him sneak up behind me and blow it when I thought I was alone in the kitchen was the final straw). Oh and a plastic Teletubbies book which amongst other things yells “Tubby custard” when you stand on it in the dark.

Can’t wait to see what they get him for his birthday…

Empress of the Iguana People

God help you!
We get our son a lot of toddler friendly instruments. But then MiniBard is honestly trying to make music and does a decent job for someone still in diapers.

Empress of the Iguana People

Hi, Erin. We hope everything’s going well for you and the family. *hugs*

Roadstergal

Echoing Empress – we’re thinking of you, and hoping things went ok with you and yours. *hugs*

Empress of the Iguana People

My brother was good friends with the vaccuum cleaner when he was 3 or so. Mom kept it in our closet next to the toybox and he’d sit in there for ages chattering away at it.

Amazed

Mine was best friends/worse enemies with the bear he got for his 2nd nameday. He adored it. For about a minute. Before the thing roared. Healthy respect came in play immediately. When he was feeling particularly brave, Dad took Bear out of the closet and the two of them wrestled.

The Computer Ate My Nym

Do you know what the criteria are for something to be FDA approved? Or how many drugs are FDA approved as being safe in pregnancy? (Yes, this is a trick question.)

Maternal mortality is rising in the US because of anti-abortion laws and harassment of providers. It went up to third world levels in Texas after the anti-abortion forces closed clinics and made it harder for women who are ill to end pregnancies that endanger them–or for women desiring to carry the pregnancy to term to find care. It’s not about too many c-sections, it’s about too little prenatal care.

Yes, and what you identify is only part of the problem. Reducing funding for Planned Parenthood in Texas denies women healthcare in general; abortion services are only about 3% of the services that PP offers. “. . . the increase in recent years has been driven by heart problems and other chronic medical conditions, like diabetes, which has increased sharply in the population. Researchers have theorized that an increase in obesity — particularly acute among poor black women, who have much higher rates of maternal mortality than whites — may be contributing to the problem.”

The Computer Ate My Nym

I’m dubious about obesity being a major contributor. For one thing, the rate of obesity is stabilizing, for another the increase is extremely prominent in Texas and obesity isn’t the thing that’s changing in Texas. It’s PP funding.

Box of Salt

CAMN,
Thanks for posting. This is interesting, and in a bad way. I wish there was a link to the report included. It makes me wonder how much “abstinence only” sex ed contributes to the mortality rate.

Daleth

Nikilee, do you know how epidurals work? Namely, that the drug is injected directly into the space around the spine, NOT into the woman’s bloodstream? That’s why a woman with an epidural is conscious and able to move and feel everything in every other part of her body: because the drug just numbs her spine itself. It doesn’t go systemic. All it does is prevent “messages” of pain from going up the spine to her brain where she would feel them.

Worrying about the effect of mom getting an epidural on a baby is like worrying about the effect of mom getting a cast on a broken arm.

Heidi

“There is no labor drug FDA-approved for infant safety.”

She never addresses why she is okay with practicing homeopathy or craniosacral therapy (on babies!), which have never been proven to be safe and more importantly has never been proven to work.

nikkilee

Baby cord blood analysis has showed traces of epidural medication and changes in infant cord blood gases. If the epidural stays in the epidural space, how come the medication has to be administered continually?

Roadstergal

Nikkilee, you never answered my Q below about chronic health issues population-wise for the FF vs the BF generation. With your penetrating scientific mind, surely this must be easy.

When you post a study that says that, we’ll have something to discuss. If we just argued about what individual people said here, we wouldn’t be arguing about science or medicine; we’d be arguing about personal opinions, misremembered factoids and the like.

If the epidural stays in the epidural space, how come the medication has to be administered continually?

Well, it doesn’t, actually–it’s normally administered intermittently (as needed), not continuously. Anyway, how come you need to take Advil every four hours when you have a headache, instead of just once? How come your dentist needs to give you more shots if your root canal takes longer than expected? Because medication breaks down and wears off. We’re not talking about plutonium here. Medications, unlike nuclear materials, do not just continue existing unchanged for indefinite periods of time after being put into the human body. I will leave a more detailed answer to a doctor or nurse with the appropriate knowledge base, but that’s the gist.

nikkilee

It is continuous in hospitals in my region. There are local variations.

Roadstergal

Hey, nikkilee, what are the metabolic pathways and PK of the medications in epidurals? What are the NOEL and NOAEL in each compartment in which they are detectable? You surely must know these things if you’re stating that the current practice is unsafe.

Daleth

It’s been 2 days and you still haven’t posted anything to back up your claim that baby cord blood analysis has shown traces of epidural meds and changes in cord-blood gases. Hmm.

Melaniexxxx

OT but sorta not OT: https://www.midirs.org/midwifery-africa-less-daunting-working-nhs/
WTF is this crap? Direct entry white MW who has worked all of two years keen to run off and “teach” things in “Africa” (Zambia to be precise) where REAL midwifery occurs, like breech birth, and women’s bodies doing what they were meant to do, rather than having to worry about ‘repercussions of a bad outcome”

MI Dawn

Nope. Nope, nope, nope. NOT going over there to read that. I’m in a happy mood right now…

sdsures

Oh dear.

Mattie

Ugh I read this… the really concerning thing is that she seems to be going there so she can get away with doing things outside her scope of practice, which they do over there because otherwise women and babies will die. It’s scary that she thinks that way, and scarier that she may return to the UK and continue practicing that way.

RMY

>”rubbing women’s backs as they powerfully and effortlessly bring new life into the world”

I just can’t, the process is called LABOR, it is NOT EFFORTLESS.

Box of Salt

“rather than having to worry about ‘repercussions of a bad outcome” ”

If she thinks she won’t be seeing bad outcomes, she’s in for a world of disillusionment.

The Bofa on the Sofa

No, there just won’t be any repercussions from them. She is saying she can go there and kill with impunity.

sdsures

“Poor children and children of color face a plethora of truly life-threatening issues including hunger, lack of access to healthcare and gun violence. Poor children and children of color die each and every day because of these problems, but manyprivileged [sic] Western, white well off parents could care less. They oppose life saving free school meals, Obamacare and sensible gun regulations.”

Trump is only going to make life harder for poor children and children of colour. However, I want to argue that gun violence, as it stands in the US, can affect ANYONE in ANY class, because of the absurd ease with which anyone can get their hands on firearms in the US. :'(

I would say at first “side effect”, because I haven’t seen (yet) anyone in NCB circles gloating over how miserable some women can be because they have been made to feel guilty about having c-sections or epidurals.

It doesn’t mean it’s not a goal – just that I haven’t yet seen it happen. I have little doubt that it will eventually happen. 🙁

CSN0116

Check out Dr. Amy’s FB page right now. There’s some quack going off about how she openly professes that she was superior in providing her children breast milk and gave them the best start in life. She says the only people upset by her gospel know they failed and more or less should be upset by their failure.

So, I don’t know. There seemed to be some fucked up women out there truly getting happy over the suffering of others’ self-labeled inferiority.

BeatriceC

Oh…I should head over there. I breastfed all of mine and think people like that are idiots.

Empress of the Iguana People

I’d go too, but discussing it is not great for my mental state just now.

sdsures

I’ve seen her stuff. Yikes.

Christy

It makes me so sad every time I see a woman on the internet distraught because she “failed” at breastfeeding or nonmedicated birth or had a c section to save her baby. None of these things are failures! Parenting is hard enough, we shouldn’t have this artificial pressure to contend with as well.

I thought about that a lot while I was in the hospital after Spawn was CS’ed and I was pumping to see if I had breast milk.

Since I was a FTM and was at 26 weeks gestation when Spawn underwent an emergency CS to save both of our lives, I didn’t expect to get much – if any- milk, but had an annoying-as-hell lactation consultant who was giving me bat-shit crazy advice like “It’s critical for you to pump every two hours” – even thought the OB special care nurses and my actual freaking OB were strongly recommending focusing on sleeping in at least 4 hour blocks during the night/evening to help me recover from HELLP and the CS.

Thankfully, my mom and husband acted as voices of reason – but I couldn’t help but think how shitty the situation would have been for someone who didn’t live on a dairy farm with protective family members….

And – ironically – I have been able to pump decent amounts of breast milk without having pumped every 2 hours for the first two weeks. Plenty to keep my little boy fed so far and power pumping every few days has kept my supply increasing as well……

Sue

Cos the lactation consultant only holds responsibility for ONE outcome, whereas the other clinicians need you and baby to be well overall.